The Prevalence of Osteoporosis, Osteopenia, and Fractures Among Adults with Cystic Fibrosis: A Systematic Literature Review with Meta-Analysis

Abstract

Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density for adult patients with cystic fibrosis. Fracture complications were also described. The objective of this study was to determine the prevalence of osteoporosis, osteopenia, and fractures among adult patients with cystic fibrosis. A systematic literature review was conducted using electronic databases. The keywords used were "cystic fibrosis [MeSH] AND bone density." Original studies were eligible if they reported the prevalence of osteoporosis and/or osteopenia and/or fractures in adult patients with cystic fibrosis. A meta-analysis of pooled proportions was performed. Heterogeneity was tested with the Cochran Q statistic, and in the case of heterogeneity a random effect model was used. Of 117 studies, 12 were selected, i.e., that represented a total of 1055 patients. Mean age ranged from 18.5 to 32 years (median: 28.2 years). Mean body mass index ranged from 19.9 to 22.4 (median: 20.7); 53.8% were men. The pooled prevalence of osteoporosis in adults with cystic fibrosis was 23.5% (95% CI, 16.6-31.0). The pooled prevalence of osteopenia was 38% (95% CI, 28.2-48.3). The pooled prevalences of radiological vertebral fractures and nonvertebral fractures were 14% (95% CI, 7.8-21.7) and 19.7% (95% CI, 6.0-38.8), respectively. In conclusion, this systematic literature review with meta-analysis emphasized the high prevalence of osteopenia and osteoporosis in young adults with cystic fibrosis. The prevalence of fracture was also high.

Prevalence of low bone mineral density in adolescents and adults with cystic fibrosis

“…Several studies described lower bone mass density (BMD) in patients with CF, which increases fracture risk [5][6][7][8] . Bone fractures can cause pain, decrease respiratory status, and are a contraindication for lung transplantation in these patients 9,10 . Cross-sectional studies in adults (age range from 16-60 years) with CF demonstrated that 6 to 68% had Z-scores ≤-2.0 8,[11][12][13][14][15][16] .…”

Nutritional status disorders in cystic fibrosis – dietary recommendations and supplementation. A review

“…Dane zebrane przez Paccou i wsp. [15] wskazują na występowanie osteo porozy u blisko 24% chorych na CF, osteopenii u 38%, zła mań kręgów doznało 14%, a innych złamań ok. 20% pac jentów.…”

Osteoporoza w mukowiscydozie/ Osteoporosis in cystic fibrosis

“…Pomimo upływu ponad 30 lat od pierwszych badań, temat ten nadal jest aktualny i poruszany przez wielu autorów, szczególnie w ostatnim dziesięcioleciu. Według danych zebranych przez Paccou i współautorów osteoporoza dotyka 23,5% chorych na mukowiscydozę, 38% chorych ma osteopenię, złamań kręgów doświadczyło 14% pacjentów natomiast innych złamań 19,7% [6]. Etiologia zmian gęstości kości w przebiegu mukowiscydozy jest wieloprzyczynowa: niedobór witamin głównie jako wynik niewydolności trzustki, cukrzyca, leczenie przewlekłego zapalenia oskrzeli za pomocą glikokortykosteroidów, niedobór hormonów płciowych oraz obecność niektórych cytokin.…”