title: Longitudinal analysis of vertebral fracture and BMD in a Canadian cohort of adult cystic fibrosis patients.
abstract: 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.
authors.affiliation: Department of Medicine, McMaster University, 1200 Main St W., Hamilton ON, L8N 3Z5, Canada. papaioannou@hhsc.ca
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Kennedy
authors.forename: Andreas
authors.initials: A
authors.lastname: Freitag
authors.forename: John
authors.initials: J
authors.lastname: O'Neill
authors.forename: Margaret
authors.initials: M
authors.lastname: Pui
authors.forename: George
authors.initials: G
authors.lastname: Ioannidis
authors.forename: Colin
authors.initials: C
authors.lastname: Webber
authors.forename: Anjali
authors.initials: A
authors.lastname: Pathak
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hansen
authors.forename: Rosamund
authors.initials: R
authors.lastname: Hennessey
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
mesh_terms: 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
references.citation: Osteoporos Int. 2004 Feb;15(2):108-12
references.pmid: 14598026
references.citation: Osteoporos Int. 2003 Jan;14(1):61-8
references.pmid: 12577186
references.citation: Lancet. 1999 Mar 13;353(9156):878-82
references.pmid: 10093980
references.citation: Osteoporos Int. 1999;10(4):278-83
references.pmid: 10692975
references.citation: J Clin Densitom. 2000 Fall;3(3):281-90
references.pmid: 11090235
references.citation: Thorax. 2002 Aug;57(8):719-23
references.pmid: 12149534
references.citation: J Bone Miner Res. 1999 May;14(5):821-8
references.pmid: 10320531
references.citation: Bone. 2004 Sep;35(3):771-6
references.pmid: 15336615
references.citation: BMC Musculoskelet Disord. 2002 Apr 22;3:11
references.pmid: 11967146
references.citation: Osteoporos Int. 2001;12(5):366-72
references.pmid: 11444084
references.citation: Osteoporos Int. 2004 Feb;15(2):113-9
references.pmid: 14618303
references.citation: Osteoporos Int. 1993 May;3(3):120-6
references.pmid: 8481587
references.citation: Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):789-94
references.pmid: 10988084
references.citation: Chest. 2006 Aug;130(2):539-44
references.pmid: 16899856
references.citation: JAMA. 2001 Jan 17;285(3):320-3
references.pmid: 11176842
references.citation: Calcif Tissue Int. 2007 Jan;80(1):44-9
references.pmid: 17205331
references.citation: Am J Respir Crit Care Med. 2004 Jan 1;169(1):77-82
references.pmid: 14563654
references.citation: Am J Epidemiol. 1993 May 1;137(9):1001-5
references.pmid: 8317445
references.citation: Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):941-6
references.pmid: 10988110
references.citation: Osteoporos Int. 2003;14 Suppl 3:S43-55
references.pmid: 12730798
references.citation: Am J Med. 2002 Aug 15;113(3):220-8
references.pmid: 12208381
references.citation: Osteoporos Int. 2004 Oct;15(10):834-41
references.pmid: 15045468
references.citation: Drugs. 2004;64(2):133-47
references.pmid: 14717616
references.citation: Chest. 2008 Oct;134(4):794-800
references.pmid: 18641106
references.citation: J Clin Endocrinol Metab. 2005 Mar;90(3):1888-96
references.pmid: 15613415
references.citation: Can Assoc Radiol J. 2007 Feb;58(1):27-36
references.pmid: 17408160
references.citation: Arthritis Rheum. 2001 Nov;44(11):2611-9
references.pmid: 11710717
references.citation: Chest. 2004 Jan;125(1 Suppl):1S-39S
references.pmid: 14734689
references.citation: Thorax. 2000 Sep;55(9):798-804
references.pmid: 10950902
references.citation: Drugs Aging. 2007;24(7):529-35
references.pmid: 17658904
references.citation: Osteoporos Int. 2000;11(12):985-1009
references.pmid: 11256898
references.citation: Osteoporos Int. 2000;11(8):680-7
references.pmid: 11095171
references.citation: Lancet. 2004 Jan 17;363(9404):197-202
references.pmid: 14738792
references.citation: Thorax. 2004 Jul;59(7):613-7
references.pmid: 15223873
references.citation: J Bone Miner Res. 2003 Jul;18(7):1254-60
references.pmid: 12854835
references.citation: J Bone Miner Res. 2000 Apr;15(4):721-39
references.pmid: 10780864
references.citation: Ann Intern Med. 1998 Feb 1;128(3):186-93
references.pmid: 9454526