Patients undergoing lung transplant should be screened annually with dual energy x-ray absorptiometry (DEXA) for the first two years after the surgery to monitor their bone health, according to results of a recent study.
Researchers led by Ronnie Sebro, MD, PhD, of the Mayo Clinic in Jacksonville, FL, found that patients experience a loss in bone mineral density (BMD) after transplant, which puts them at higher risk for osteoporosis and fractures.
“Early detection of patients with low BMD may allow for intervention and treatment before the development of fractures,” the group wrote. The study was published November 7 in the Journal of Heart and Lung Transplantation.
Approximately 2,700 lung transplants are performed annually in the U.S. Several factors may contribute to the development of decreased BMD in these patients, including the lack of physical activity due to preexisting conditions that led to the transplant, or decreased physical activity after the transplant itself, the researchers explained. In addition, immunosuppressive corticosteroids to prevent organ rejection have also been associated with increased bone loss and decreased BMD over time.
DEXA is the gold standard imaging method for screening for low BMD. Thus, in this study, the group aimed to determine the rate of BMD loss in transplant patients and the best screening interval.
The researchers retrospectively analyzed data from 259 patients aged 50 or older who had lung transplants between January 2010 and December 2023. Patients had to have at least two DXA scans, one within a year prior to transplantation, and the other after a median of 725 days after transplantation to be included in the study.
DXA scans were used to obtain areal BMD measurements at the L1-L4 lumbar spine, total hip, and femoral neck.
According to the findings, 65% of the patients had osteopenia or osteoporosis before transplant, with men exhibiting higher baseline BMD levels compared with women at all sites (p < 0.001). The analysis showed that after transplant, the rate of BMD loss was fastest at the femoral neck, but faster in patients with normal BMD at baseline than in patients with osteopenia or osteoporosis at baseline prior to transplant (p < 0.001).
“We estimated that a significant change in the femoral neck BMD would be expected to occur within 409 days and again at 867 days after lung transplant,” the group wrote.
Ultimately, the balance between frequent DEXA screening and preventive intervention such as bisphosphonates (osteoporosis medications) needs to be carefully weighed, the group noted.
On one hand, frequent DEXA scans could detect BMD loss early in these patients, but at a higher financial cost. On the other, early preventive measures after transplant might stabilize bone health and reduce the need for constant monitoring and thus potentially lower long-term expenses, they wrote.
“The ideal approach could be a hybrid model, with targeted DEXA screening for high-risk individuals, combined with universal preventive measures early in the post-transplant phase,” the group concluded.
The full study is available here.
