1
|
Wilschanski M, Munck A, Carrion E, Cipolli M, Collins S, Colombo C, Declercq D, Hatziagorou E, Hulst J, Kalnins D, Katsagoni CN, Mainz JG, Ribes-Koninckx C, Smith C, Smith T, Van Biervliet S, Chourdakis M. ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis. Clin Nutr 2024; 43:413-445. [PMID: 38169175 DOI: 10.1016/j.clnu.2023.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented. METHODS The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members. RESULTS The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.
Collapse
Affiliation(s)
- Michael Wilschanski
- Pediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Anne Munck
- Cystic Fibrosis Centre, Hopital Necker-Enfants Malades, AP-HP, Paris, France
| | - Estefania Carrion
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Marco Cipolli
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sarah Collins
- CF Therapies Team, Royal Brompton & Harefield Hospital, London, UK
| | - Carla Colombo
- University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dimitri Declercq
- Cystic Fibrosis Reference Centre, Ghent University Hospital and Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Elpis Hatziagorou
- Cystic Fibrosis Unit, 3rd Pediatric Dept, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Jessie Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics and Department of Nutritional Sciences, The University of Toronto, Toronto, Canada
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
| | - Christina N Katsagoni
- Department of Clinical Nutrition, Agia Sofia Children's Hospital, Athens, Greece; EFAD, European Specialist Dietetic Networks (ESDN) for Gastroenterology, Denmark
| | - Jochen G Mainz
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology and Paediatric Cystic Fibrosis Unit. La Fe Hospital & La Fe Research Institute, Valencia, Spain
| | - Chris Smith
- Department of Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Thomas Smith
- Independent Patient Consultant Working at Above-disease Level, UK
| | | | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
2
|
Ireland A, Riddell A, Colombo A, Ross-Russell R, Prentice A, Ward KA. Development of musculoskeletal deficits in children with cystic fibrosis in later childhood. Bone 2023; 170:116657. [PMID: 36690166 DOI: 10.1016/j.bone.2022.116657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
Cystic fibrosis (CF) is a genetic condition primarily affecting the respiratory system, with the associated progressive lung damage and loss of function resulting in reduced lifespan. Bone health is also impaired in individuals with CF, leading to much higher fracture risk even in adolescence. However, the development of these deficits during growth and the relative contributions of puberty, body size and muscular loading remain somewhat unexplored. We therefore recruited 25 children with CF (10 girls, mean age 11.3 ± 2.9y) and 147 children without CF (75 girls, mean age 12.4 ± 2.6y). Bone characteristics were assessed using peripheral quantitative computed tomography (pQCT) at 4 % and 66 % distal-proximal tibia. Muscle cross-sectional area (CSA) and density (an indicator of muscle quality) were also assessed at the latter site. Tibial bone microstructure was assessed using high-resolution pQCT (HR-pQCT) at 8 % distal-proximal tibial length. In addition, peak jump power and hop force were measured using jumping mechanography. Group-by-age interactions and group differences in bone and muscle characteristics were examined using multiple linear regression, adjusted for age, sex and pubertal status and in additional models, height and muscle force. In initial models group-by-age interactions were evident for distal tibial total bone mineral content (BMC) and trabecular volumetric bone mineral density (vBMD), with a lower rate of age-related accrual evident in children with CF. In assessments of distal tibial microstructure, similar patterns were observed for trabecular number and thickness, and cortical CSA. In the tibial shaft, group-by-age interactions indicating slower growth in CF were evident for total BMC and cortical CSA, whilst age-independent deficits in CF were observed for several other variables. Peak jump power and hop force also exhibited similar interactions. Group-by-age interactions for bone were partially attenuated at the distal tibia and fully attenuated at the tibial shaft by adjustment for muscle force. These results suggest that bone and muscle deficits in children with CF develop throughout later childhood, independent of differences in pubertal stage and body size. These diverging growth patterns appear to be mediated by differences in muscle function, particularly for bone characteristics in the tibial shaft. Given the high fracture risk in this population from childhood onwards, development of interventions to improve bone health would be of substantial clinical value.
Collapse
Affiliation(s)
- Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Amy Riddell
- Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St. George's University of London, UK; Previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Antony Colombo
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK; UMR 5199 PACEA, EPHE-PSL University, Pessac, France; Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, Italy; Department of Anthropology, Pennsylvania State University, PA, USA
| | - Robert Ross-Russell
- Department of Paediatric Respiratory Medicine, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Ann Prentice
- Previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; MRC Nutrition and Bone Health Group, Cambridge, UK
| | - Kate A Ward
- MRC Nutrition and Bone Health Group, Cambridge, UK.
| |
Collapse
|
3
|
Fonseca Ó, Gomes MS, Amorim MA, Gomes AC. Cystic Fibrosis Bone Disease: The Interplay between CFTR Dysfunction and Chronic Inflammation. Biomolecules 2023; 13:biom13030425. [PMID: 36979360 PMCID: PMC10046889 DOI: 10.3390/biom13030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
Cystic fibrosis is a monogenic disease with a multisystemic phenotype, ranging from predisposition to chronic lung infection and inflammation to reduced bone mass. The exact mechanisms unbalancing the maintenance of an optimal bone mass in cystic fibrosis patients remain unknown. Multiple factors may contribute to severe bone mass reduction that, in turn, have devastating consequences in the patients' quality of life and longevity. Here, we will review the existing evidence linking the CFTR dysfunction and cell-intrinsic bone defects. Additionally, we will also address how the proinflammatory environment due to CFTR dysfunction in immune cells and chronic infection impairs the maintenance of an adequate bone mass in CF patients.
Collapse
Affiliation(s)
- Óscar Fonseca
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Maria Salomé Gomes
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS-Instuto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, 4030-313 Porto, Portugal
| | | | - Ana Cordeiro Gomes
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- IBMC-Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| |
Collapse
|
4
|
Lei WS, Kilberg MJ, Zemel BS, Rubenstein RC, Harris C, Sheikh S, Kelly A, Kindler JM. Bone metabolism and incretin hormones following glucose ingestion in young adults with pancreatic insufficient cystic fibrosis. J Clin Transl Endocrinol 2022; 30:100304. [PMID: 36110921 PMCID: PMC9467887 DOI: 10.1016/j.jcte.2022.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Gut-derived incretin hormones, including glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide 1 (GLP-1), regulate post-prandial glucose metabolism by promoting insulin production. GIP, GLP-1, and insulin contribute to the acute bone anti-resorptive effect of macronutrient ingestion by modifying bone turnover. Cystic fibrosis (CF) is associated with exocrine pancreatic insufficiency (PI), which perturbs the incretin response. Cross-talk between the gut and bone ("gut-bone axis") has not yet been studied in PI-CF. The objectives of this study were to assess changes in biomarkers of bone metabolism during oral glucose tolerance testing (OGTT) and to test associations between incretins and biomarkers of bone metabolism in individuals with PI-CF. Methods We performed a secondary analysis of previously acquired blood specimens from multi-sample OGTT from individuals with PI-CF ages 14-30 years (n = 23). Changes in insulin, incretins, and biomarkers of bone resorption (C-terminal telopeptide of type 1 collagen [CTX]) and formation (procollagen type I N-terminal propeptide [P1NP]) during OGTT were computed. Results CTX decreased by 32% by min 120 of OGTT (P < 0.001), but P1NP was unchanged. Increases in GIP from 0 to 30 mins (rho = -0.48, P = 0.03) and decreases in GIP from 30 to 120 mins (rho = 0.62, P = 0.002) correlated with decreases in CTX from mins 0-120. Changes in GLP-1 and insulin were not correlated with changes in CTX, and changes in incretins and insulin were not correlated with changes in P1NP. Conclusions Intact GIP response was correlated with the bone anti-resorptive effect of glucose ingestion, represented by a decrease in CTX. Since incretin hormones might contribute to development of diabetes and bone disease in CF, the "gut-bone axis" warrants further attention in CF during the years surrounding peak bone mass attainment.
Collapse
Affiliation(s)
- Wang Shin Lei
- Department of Nutritional Sciences, The University of Georgia, Athens, GA, USA
| | - Marissa J. Kilberg
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Babette S. Zemel
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ronald C. Rubenstein
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Clea Harris
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Saba Sheikh
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph M. Kindler
- Department of Nutritional Sciences, The University of Georgia, Athens, GA, USA
| |
Collapse
|
5
|
Williams KM, Darukhanavala A, Hicks R, Kelly A. An update on methods for assessing bone quality and health in Cystic fibrosis. J Clin Transl Endocrinol 2022; 27:100281. [PMID: 34984171 PMCID: PMC8693345 DOI: 10.1016/j.jcte.2021.100281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/18/2021] [Accepted: 11/27/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kristen M. Williams
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Columbia University Irving Medical Center, 1150 St Nicholas Avenue, New York, NY, USA
- Corresponding author at: Division of Pediatric Endocrinology, Diabetes, and Metabolism, Columbia University Irving Medical Center, 1150 St Nicholas Avenue, 2 Floor, New York, NY 10032, USA.
| | - Amy Darukhanavala
- Division of Pediatric Endocrinology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA, USA
| | - Rebecca Hicks
- Division of Pediatric Endocrinology, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, MDCC 22-315, Los Angeles, CA, USA
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, USA
| |
Collapse
|
6
|
Orlando V, Morin G, Laffont A, Lénart D, Solórzano Barrera C, Mustafy T, Sankhe S, Villemure I, Mailhot G. CFTR deletion affects mouse osteoblasts in a gender-specific manner. J Cell Physiol 2020; 235:6736-6753. [PMID: 31985038 DOI: 10.1002/jcp.29568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/10/2020] [Indexed: 12/24/2022]
Abstract
Advancements in research and care have contributed to increase life expectancy of individuals with cystic fibrosis (CF). With increasing age comes a greater likelihood of developing CF bone disease, a comorbidity characterized by a low bone mass and impaired bone quality, which displays gender differences in severity. However, pathophysiological mechanisms underlying this gender difference have never been thoroughly investigated. We used bone marrow-derived osteoblasts and osteoclasts from Cftr+/+ and Cftr-/- mice to examine whether the impact of CF transmembrane conductance regulator (CFTR) deletion on cellular differentiation and functions differed between genders. To determine whether in vitro findings translated into in vivo observations, we used imaging techniques and three-point bending testing. In vitro studies revealed no osteoclast-autonomous defect but impairment of osteoblast differentiation and functions and aberrant responses to various stimuli in cells isolated from Cftr-/- females only. Compared with wild-type controls, knockout mice exhibited a trabecular osteopenic phenotype that was more pronounced in Cftr-/- males than Cftr-/- females. Bone strength was reduced to a similar extent in knockout mice of both genders. In conclusion, we find a trabecular bone phenotype in Cftr-/- mice that was slightly more pronounced in males than females, which is reminiscent of the situation found in patients. However, at the osteoblast level, the pathophysiological mechanisms underlying this phenotype differ between males and females, which may underlie gender differences in the way bone marrow-derived osteoblasts behave in absence of CFTR.
Collapse
Affiliation(s)
- Valérie Orlando
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada
| | - Geneviève Morin
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada
| | - Alisson Laffont
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada
| | - Déborah Lénart
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada
| | - Carolina Solórzano Barrera
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada.,Department of Mechanical Engineering, École Polytechnique of Montréal, Station Centre-Ville, Montréal, Quebec, Canada
| | - Tanvir Mustafy
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada.,Department of Mechanical Engineering, École Polytechnique of Montréal, Station Centre-Ville, Montréal, Quebec, Canada
| | - Safiétou Sankhe
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada
| | - Isabelle Villemure
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada.,Department of Mechanical Engineering, École Polytechnique of Montréal, Station Centre-Ville, Montréal, Quebec, Canada
| | - Geneviève Mailhot
- Research Centre, CHU Sainte-Justine, Montreal, Montreal, Quebec, Canada.,Department of Nutrition, Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Guérin S, Durieu I, Sermet-Gaudelus I. Cystic Fibrosis-Related Bone Disease: Current Knowledge and Future Directions. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
8
|
Braux J, Jourdain ML, Guillaume C, Untereiner V, Piot O, Baehr A, Klymiuk N, Winter N, Berri M, Buzoni-Gatel D, Caballero I, Guillon A, Si-Tahar M, Jacquot J, Velard F. CFTR-deficient pigs display alterations of bone microarchitecture and composition at birth. J Cyst Fibros 2019; 19:466-475. [PMID: 31787573 DOI: 10.1016/j.jcf.2019.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/07/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lack of cystic fibrosis transmembrane conductance regulator (CFTR) function causes cystic fibrosis (CF), predisposing to severe lung disease, reduced growth and osteopenia. Both reduced bone content and strength are increasingly recognized in infants with CF before the onset of significant lung disease, suggesting a developmental origin and a possible role in bone disease pathogenesis. The role of CFTR in bone metabolism is unclear and studies on humans are not feasible. Deletion of CFTR in pigs (CFTR -/- pigs) displays at birth severe malformations similar to humans in the intestine, respiratory tract, pancreas, liver, and male reproductive tract. METHODS We compared bone parameters of CFTR -/- male and female pigs with those of their wild-type (WT) littermates at birth. Morphological and microstructural properties of femoral cortical and trabecular bone were evaluated using micro-computed tomography (μCT), and their chemical compositions were examined using Raman microspectroscopy. RESULTS The integrity of the CFTR -/- bone was altered due to changes in its microstructure and chemical composition in both sexes. Low cortical thickness and high cortical porosity were found in CFTR -/- pigs compared to sex-matched WT littermates. Moreover, an increased chemical composition heterogeneity associated with higher carbonate/phosphate ratio and higher mineral crystallinity was found in CFTR -/- trabecular bone, but not in CFTR -/- cortical bone. CONCLUSIONS The loss of CFTR directly alters the bone composition and metabolism of newborn pigs. Based on these findings, we speculate that bone defects in patients with CF could be a primary, rather than a secondary consequence of inflammation and infection.
Collapse
Affiliation(s)
- Julien Braux
- Université de Reims Champagne Ardenne, BIOS EA 4691, Biomatériaux et Inflammation en site osseux, SFR CAP-Santé (FED 4231), 1, Avenue du Maréchal Juin, 51097 Reims, France
| | - Marie-Laure Jourdain
- Université de Reims Champagne Ardenne, BIOS EA 4691, Biomatériaux et Inflammation en site osseux, SFR CAP-Santé (FED 4231), 1, Avenue du Maréchal Juin, 51097 Reims, France
| | - Christine Guillaume
- Université de Reims Champagne Ardenne, BIOS EA 4691, Biomatériaux et Inflammation en site osseux, SFR CAP-Santé (FED 4231), 1, Avenue du Maréchal Juin, 51097 Reims, France
| | - Valérie Untereiner
- Université de Reims Champagne Ardenne (URCA), PICT Platform, Reims, 1, Avenue du Maréchal Juin, 51097 Reims, France
| | - Olivier Piot
- Université de Reims Champagne-Ardenne, BioSpecT (Translational BioSpectroscopy) EA 7506, 1, Avenue du Maréchal Juin, 51097 Reims, France
| | - Andrea Baehr
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universitat Munchen, Hackerstrasse 27, 85764, Oberschleissheim, Germany
| | - Nikolai Klymiuk
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universitat Munchen, Hackerstrasse 27, 85764, Oberschleissheim, Germany
| | - Nathalie Winter
- INRA, UMR1282 ISP, Centre de recherches INRA Val de Loire, 37380, Nouzilly, France
| | - Mustapha Berri
- INRA, UMR1282 ISP, Centre de recherches INRA Val de Loire, 37380, Nouzilly, France
| | | | - Ignaccio Caballero
- INRA, UMR1282 ISP, Centre de recherches INRA Val de Loire, 37380, Nouzilly, France
| | - Antoine Guillon
- Inserm, Centre d'Etude des Pathologies Respiratoires, UMR1100/EA6305, 10 Boulevard Tonnellé, 37032, Tours, France
| | - Mustapha Si-Tahar
- Inserm, Centre d'Etude des Pathologies Respiratoires, UMR1100/EA6305, 10 Boulevard Tonnellé, 37032, Tours, France
| | - Jacky Jacquot
- Université de Reims Champagne Ardenne, BIOS EA 4691, Biomatériaux et Inflammation en site osseux, SFR CAP-Santé (FED 4231), 1, Avenue du Maréchal Juin, 51097 Reims, France.
| | - Frédéric Velard
- Université de Reims Champagne Ardenne, BIOS EA 4691, Biomatériaux et Inflammation en site osseux, SFR CAP-Santé (FED 4231), 1, Avenue du Maréchal Juin, 51097 Reims, France.
| |
Collapse
|
9
|
Feijó Andrade RG, Forte GC, Hochhegger B, Pinto LA. Bone mineral density in cystic fibrosis patients using low-dose chest computed tomography: a pilot study. Eur Respir J 2019; 53:13993003.00066-2019. [PMID: 30923186 DOI: 10.1183/13993003.00066-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/13/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Rubens Gabriel Feijó Andrade
- Programa de Pós-graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriele Carra Forte
- Programa de Pós-graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Araujo Pinto
- Programa de Pós-graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
10
|
Jardel S, Reynaud Q, Durieu I. Long-term extrapulmonary comorbidities after lung transplantation in cystic fibrosis: Update of specificities. Clin Transplant 2018; 32:e13269. [DOI: 10.1111/ctr.13269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Sabine Jardel
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center; Hospices Civils de Lyon; Lyon France
- EA HESPER 7425; Université Claude Bernard Lyon 1; Lyon France
| | - Quitterie Reynaud
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center; Hospices Civils de Lyon; Lyon France
- EA HESPER 7425; Université Claude Bernard Lyon 1; Lyon France
| | - Isabelle Durieu
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center; Hospices Civils de Lyon; Lyon France
- EA HESPER 7425; Université Claude Bernard Lyon 1; Lyon France
| |
Collapse
|
11
|
Schendel A, Mai J, Espinosa R, Tomcyzk CT, Laguna TA. Unexpected Height Loss in an Adolescent With Cystic Fibrosis. Glob Pediatr Health 2018; 5:2333794X18773662. [PMID: 29761141 PMCID: PMC5946352 DOI: 10.1177/2333794x18773662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/30/2018] [Indexed: 12/04/2022] Open
Abstract
This case report describes an adolescent with pancreatic insufficient cystic fibrosis, malnutrition, and cystic fibrosis–related diabetes found to have a loss in height at a routine outpatient clinic visit. He was subsequently admitted to the hospital for treatment of a pulmonary exacerbation and was found to have multiple, nontraumatic vertebral compression fractures. This report emphasizes the importance of routine review of growth charts and aggressive treatment of vitamin deficiencies and malnutrition in people with cystic fibrosis.
Collapse
Affiliation(s)
| | - Jillian Mai
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Rachel Espinosa
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Carlye T Tomcyzk
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Theresa A Laguna
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| |
Collapse
|
12
|
O’Brien CE, Com G, Fowlkes J, Tang X, James LP. Peripheral quantitative computed tomography detects differences at the radius in prepubertal children with cystic fibrosis compared to healthy controls. PLoS One 2018; 13:e0191013. [PMID: 29324908 PMCID: PMC5764746 DOI: 10.1371/journal.pone.0191013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/27/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction In 2015, 11.9% of people with cystic fibrosis (CF) in the United States had osteopenia, 5.1% osteoporosis, and 0.3% experienced a fracture. Screening for CF-related bone disease starts in childhood, and dual energy x-ray absorptiometry (DXA) is the recommended method. It is unknown whether peripheral quantitative computed tomography (pQCT) can detect deficits earlier than DXA. This study compared pQCT and DXA scans in a group of pre-pubertal children with CF and healthy controls. Methods This was a cross-sectional study of children at Tanner stage 1. A pQCT scan of the radius at proximal and distal sites was performed plus a total body DXA scan. Serum C-reactive protein, interleukin-6 and tumor necrosis factor-alpha were also measured. Results A total of 34 subjects completed the study; 14 with CF and 20 controls. At the distal radius, pQCT showed a lower total bone mineral density (BMD) Z-score for the CF group (P = 0.01 and P = 0.03 for 2 different reference databases) compared to controls. At the proximal site, the polar strength-strain index was lower in the CF group (P = 0.017). Finally, the total body BMD Z-score by DXA was lower in the CF group, although it did not meet the definition of reduced bone density (P = 0.004). Biomarkers of inflammation were not different. Conclusions In this group of pre-pubertal children with CF, measures of bone strength and density by both pQCT and DXA were reduced compared to healthy controls.
Collapse
Affiliation(s)
- Catherine E. O’Brien
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas, United States of America
- * E-mail:
| | - Gulnur Com
- Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California, United States of America
| | - John Fowlkes
- Barnstable Brown Obesity and Diabetes Center University of Kentucky, Lexington, Kentucky, United States of America
| | - Xinyu Tang
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Laura P. James
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- Arkansas Children’s Hospital, Little Rock, Arkansas, United States of America
| |
Collapse
|
13
|
Braun C, Bacchetta J, Braillon P, Chapurlat R, Drai J, Reix P. Children and adolescents with cystic fibrosis display moderate bone microarchitecture abnormalities: data from high-resolution peripheral quantitative computed tomography. Osteoporos Int 2017; 28:3179-3188. [PMID: 28795206 DOI: 10.1007/s00198-017-4179-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/25/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED We investigated whether bone microstructure assessed by high-resolution peripheral quantitative tomography (HR-pQCT) could be altered in children and teenagers with cystic fibrosis (CF). In comparison to their healthy counterparts, bone microstructure was mildly affected at the tibial level only. INTRODUCTION Cystic fibrosis-related bone disease (CFBD) may alter bone health, ultimately predisposing patients to bone fractures. Our aim was to assess bone microstructure using high-resolution peripheral quantitative tomography (HR-pQCT) in a cohort of children and teenagers with CF in comparison to age-, puberty-, and gender-matched healthy volunteers (HVs). METHODS In this single-center, prospective, cross-sectional study, we evaluated the HR-pQCT bone parameters of CF patients and compared them to those of the healthy volunteers. RESULTS At a median age of 15.4 [range, 10.5-17.9] years, 37 CF patients (21 boys) with 91% [range, 46-138%] median forced expiratory volume in 1 s were included. At the ultradistal tibia, CF patients had a smaller bone cross-sectional area (579 [range, 399-1087] mm2) than HVs (655 [range, 445-981] mm2) (p = 0.027), related to a decreased trabecular area, without any significant differences for height. No other differences were found (trabecular number, separation, thickness, or distribution) at the radial or tibial levels. Bone structure was different in patients receiving ursodeoxycholic acid and those bearing two F508del mutations. CONCLUSION In our cohort of children and teenagers with good nutritional and lung function status, bone microstructure evaluated with HR-pQCT was not severely affected. Minimal microstructure abnormalities observed at the tibial level may be related to the cystic fibrosis transmembrane conductance regulator defect alone; the long-term consequences of such impairment will require further evaluation.
Collapse
Affiliation(s)
- C Braun
- Pediatric Cystic Fibrosis Center, Hospices Civils de Lyon, Lyon, France.
- University Claude-Bernard Lyon 1, Lyon, France.
- Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Femme Mère Enfant, 69677, Bron, France.
| | - J Bacchetta
- University Claude-Bernard Lyon 1, Lyon, France
- INSERM UMR 1033, Lyon, France
- Rare Renal Diseases Reference Center Néphrogones, Hospices Civils de Lyon, Lyon, France
| | - P Braillon
- University Claude-Bernard Lyon 1, Lyon, France
- Pediatric Radiology Department, Hospices Civils de Lyon, Lyon, France
| | - R Chapurlat
- University Claude-Bernard Lyon 1, Lyon, France
- INSERM UMR 1033, Lyon, France
- Pediatric Radiology Department, Hospices Civils de Lyon, Lyon, France
| | - J Drai
- Rheumatology Department, Hospices Civils de Lyon, Lyon, France
| | - P Reix
- Pediatric Cystic Fibrosis Center, Hospices Civils de Lyon, Lyon, France
- University Claude-Bernard Lyon 1, Lyon, France
- Biochemistry Department, Hospices Civils de Lyon, Lyon, France
- UMR 5558 (EMET). CNRS, LBBE, Université de Lyon, Villeurbanne, France
| |
Collapse
|