E-Poster Presentation ESA-SRB-ANZBMS 2021

Fracture incidence post lung transplantation (#757)

Lisa Raven 1 2 , Dana Bliuc 2 3 , Thach Tran 2 3 , John Eisman 1 2 3 , Jackie Center 1 2 3
  1. Department of Endocrinology, St Vincent's Hospital, Darlinghurst, NSW, Australia
  2. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  3. Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia

Osteoporosis is common post lung transplantation but data are limited on subsequent fracture risk.

 

Aim: To determine incidence of fracture in lung transplant recipients.

 

Methods: Retrospective cohort study of lung transplant recipients listed between April 2014 and September 2015 at St Vincent’s Hospital, Sydney and followed up to December 2020.

 

Results: The cohort consisted of 64 patients (35 females, 17 post-menopausal), 88% Caucasians with a mean age 48 ± 14.3 at time of transplant. During 245 person-years of follow-up, 17 patients (26.%) experienced at least one minimal trauma fracture yielding a rate of 69 fractures/1000 person-years (95% CI, 43 – 112). Crude rates were similar for women and men, however, after age-adjustment there was a non-significant trend towards a higher rate in women [HR 1.24 (0.46 - 3.36)] (figure).

A total of 53 fractures was recorded, with 11 patients experiencing multiple fractures either occurring concurrently and/or subsequently. The majority of fractures were vertebral (62%), followed by rib (20%) and most were symptomatic (66%). Of the 18 asymptomatic fractures, 16 were vertebral and 2 were rib fractures. The mean time to first fracture was 2.1 ± 1.4 years, with almost half (47%) occurring in the first year post transplant.

Women who fractured (n=9) were significantly older, had lower BMD, more likely to have COPD, a history of smoking and to be post-menopausal. For men (n=8), presence of cystic fibrosis and lower BMI were associated with a non-significant trend towards increased fracture risk.

The majority (73%) received anti-resorptive treatment before and/or after transplantation, including 11 of the 17 (65%) patients who subsequently had fractures.

 

Conclusions: One in 4 of these lung transplant recipients suffered low trauma fractures; most commonly vertebral crush fractures. To our knowledge, this is the first study to quantify fracture risk up to 6 years after lung transplantation.

 

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