title: Bone density in heart or lung transplant recipients--a longitudinal study.
abstract: BACKGROUND
  Osteoporosis is prevalent among heart or lung transplant (HLT) candidates. Bone loss is common posttransplant, with an associated increase in fracture risk. There is a lack of consensus regarding optimal management of bone health in HLT recipients. We report bone health data in a cohort of HLT recipients before and after transplantation and make recommendations for management.
  
  
  METHODS
  Patients over the age of 20 who had a heart or lung transplant between 2000 and 2011 were identified from the New Zealand HLT Service database, and demographic data, immunosuppressive regimens, bisphosphonate use, and serial bone mineral density (BMD) data were extracted.
  
  
  RESULTS
  Pretransplant BMD was available in 52 heart and 72 lung transplant recipients; 30 and 42, respectively, also had posttransplant BMD data. Pretransplant osteopenia or osteoporosis prevalence were 23% and 8% for heart candidates and 36% and 31% for lung candidates. Posttransplant, BMD decreased significantly at the femoral neck but not at the lumbar spine in the first year, with subsequent stabilization particularly in the presence of bisphosphonate use. Pretransplant BMD was the major predictor for developing osteopenia or osteoporosis after transplantation.
  
  
  CONCLUSIONS
  A significant proportion of HLT recipients have osteopenia or osteoporosis pretransplant, and this persists posttransplant. Pretransplant BMD is an important predictor of subsequent osteopenia or osteoporosis development, allowing risk stratification and targeted intervention.
authors.affiliation: Green Lane Cardiovascular Service, Aukland City Hospital, Aukland, New Zealand. TWang@adhb.govt.nz
authors.forename: T K M
authors.initials: TK
authors.lastname: Wang
authors.forename: S
authors.initials: S
authors.lastname: O'Sullivan
authors.forename: G D
authors.initials: GD
authors.lastname: Gamble
authors.forename: P N
authors.initials: PN
authors.lastname: Ruygrok
mesh_terms: D000328:Adult; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000503:physiopathology; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007166:Immunosuppressive Agents