Bone mineral density in lung transplant candidates

Introduction: The loss of bone mineral density (BMD) affects more than half of the patients on the waiting list for lung transplantation (LT), increasing their disease burden.

Objective: To describe the prevalence of BMD loss among patients evaluated as candidates for LT.

Patients and methods: We included all hospitalized patients evaluated as LT candidates over the last 3 years, excluding pediatric subjects under 17 years of age. We estimated BMD in the femoral neck and lumbar spine. Categorization used the World Health Organization criteria.

Results: Among 156 patients, 64 (41%) had chronic obstructive pulmonary disease (COPD) with only 2 (3.1%) having densitometry before referral; 55 (35.3%), interstitial lung disease (ILD) with 9 (16.4%) BMD values; and 21 (13.5%) cystic fibrosis (CF) with only 3 (14.3%) with BMD screening. The 116 patients (74.4%) who had BMD below normal values included 84.4% of COPD, 67.3% of the ILD, and 81% of the CF patients. The detection of these patients allowed us to initiate preventive treatment depending on the degree of risk of bone fracture. Half of the patients evaluated were eventually included on the LT waiting list, with 70% of them finally receiving a transplant.

Conclusions: Bone mineral loss was highly prevalent among this population but its investigation before referral for LT was scarce. Its identification allows primary or secondary prophylaxis to be started, seeking to reduce the risk of bone fracture after transplantation.