Impact of a bone health protocol on adult lung transplant recipients

Abstract

Corticosteroids are a critical component of immunosuppressive regimens following lung transplantation; however, their use is associated with known deleterious effects on bone health. Protocolized preventative therapies and screening may improve bone health in this population. We retrospectively reviewed all adult lung transplant recipients (LTRs) at a single center before and after implementation of a bone health protocol. Fifty-eight LTRs were included; 38 pre-protocol and 20 post-protocol. Significant differences were noted for patients following a bone health protocol including dual x-ray absorptiometry (DEXA) completion (16 % vs. 70 %, p = <0.001), less significant decline in femur Z- and T-scores (p = 0.05 and 0.04, respectively), and were more likely to be prescribed anti-resorptive therapy (11 % vs 40 %, p = 0.008) and calcium therapy (24 % vs. 70 %, p = <0.001). Incidence of non-procedural fracture at two years was numerically lower in the post-protocol group (21 % vs. 15 %, p = 0.58). Our data suggests that institution of a bone health protocol for lung transplant recipients improves screening, bone health pharmacotherapy, improved bone density as measured by DEXA and may reduce risk of clinically significant fractures at two years post-transplant.