Longitudinal analysis of vertebral fracture and BMD in a Canadian cohort of adult cystic fibrosis patients.
BACKGROUND
Vertebral fractures in patients with cystic fibrosis (CF) may contribute to an accelerated decline in lung function and can be a contraindication to lung transplantation. In this study, we examined longitudinal change in bone mineral density (BMD) and the prevalence of vertebral fractures in adult CF patients, without lung-transplant, attending a Canadian specialty clinic.


METHODS
Retrospective chart review of all patients attending an Adult Cystic Fibrosis Clinic at Hamilton Health Sciences in Hamilton, Canada. Forty-nine of 56 adults met inclusion criteria. Chest radiographs were graded by consensus approach using Genant's semi-quantitative method to identify and grade fractured vertebrae. Dual x-ray absorptiometry (DXA) scans were also reviewed.


RESULTS
The mean age of the cohort was 25.2 years (SD 9.4), 43% were male. The mean body mass index (BMI) was 19.8 (2.8) for males and 21.7 (5.1) for females. At baseline, the rate of at least one vertebral fracture was 16.3%; rising to 21.3% (prevalent and incident) after a 3-year follow-up. The mean BMD T-or Z-scores at baseline were -0.80 (SD 1.1) at the lumbar spine, -0.57 (SD 0.97) at the proximal femur, and -0.71 (SD 1.1) at the whole body. Over approximately 4-years, the mean percent change in BMD was -1.93% at the proximal femur and -0.73% at the lumbar spine.


CONCLUSIONS
Approximately one in five CF patients demonstrated at least one or more vertebral fractures. Moderate declines in BMD were observed. Given the high rate of vertebral fractures noted in this cohort of adult CF patients, and the negative impact they have on compromised lung functioning, regular screening for vertebral fractures should be considered on routine chest radiographs.
Papaioannou
Alexandra
A
Department of Medicine, McMaster University, 1200 Main St W., Hamilton ON, L8N 3Z5, Canada. papaioannou@hhsc.ca
Kennedy
Courtney C
CC
Freitag
Andreas
A
O'Neill
John
J
Pui
Margaret
M
Ioannidis
George
G
Webber
Colin
C
Pathak
Anjali
A
Hansen
Suzanne
S
Hennessey
Rosamund
R
Adachi
Jonathan D
JD
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D015519:Bone Density / Q000502:physiology*; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000453:epidemiology* / Q000503:physiopathology*; D055815:Young Adult
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