title: Densitometric threshold and vertebral fractures in heart transplant patients.
abstract: BACKGROUND
  Bone disease is one of the major complications of solid organ transplantation, causes considerable morbidity, and most patients are treated with immunosuppressant drugs after graft. The majority of studies reported rapid bone loss and an increased incidence of fractures after transplantation. The aim of our study was to evaluate osteoporosis and fracture prevalence, bone metabolism, and the effect of immunosuppressant agents on bone after heart transplantation.
  
  
  METHODS
  We planned a cross-sectional study in 180 heart transplant patients recruited from 3 different centers with a less than 10 years from graft. Each patient underwent a densitometric scan, and in 157 of them, an x-ray of the spine was performed to evaluate fractures. Biochemical assessment of bone metabolism was made at the time of the visit. Physical activity, diet, and calcium intake were evaluated using a specific questionnaire.
  
  
  RESULTS
  Vertebral fractures were diagnosed in 40% of subjects, but densitometric osteoporosis was observed only in 13% of spine and in 25% of hip scans. Interestingly, increasing T-score threshold up to -1.5 standard deviation, the prevalence of fractured patient improved significantly, reaching 60% in both genders. Bone content was inversely correlated with glucocorticoids, while a positive correlation was found with cyclosporine A. Almost all subjects had vitamin D deficiency.
  
  
  CONCLUSIONS
  Standard densitometric criteria are unreliable to identify bone fragility after transplantation, and a different threshold (-1.5 standard deviation) should be considered. Transplanted patients should be adequately supplemented with vitamin D, and the effects of immunosuppressant agents on bone need further investigation.
authors.affiliation: Department of Medicine, Clinic of Internal Medicine, Section D, University of Verona, Verona, Italy. luca.dallecarbonare@univr.it
authors.forename: Luca
authors.initials: L
authors.lastname: Dalle Carbonare
authors.forename: Mirko
authors.initials: M
authors.lastname: Zanatta
authors.forename: Vania
authors.initials: V
authors.lastname: Braga
authors.forename: Stefania
authors.initials: S
authors.lastname: Sella
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Vilei
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Feltrin
authors.forename: Antonio
authors.initials: A
authors.lastname: Gambino
authors.forename: Ilenia
authors.initials: I
authors.lastname: Pepe
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012307:Risk Factors; D016103:Spinal Fractures / Q000209:etiology*; D014807:Vitamin D / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy
chemical_list: D007166:Immunosuppressive Agents; D014807:Vitamin D