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Boyle RL, Psoter KJ, Merlo CA, Sidhaye AR, Lechtzin N, Patel S, Montemayor K, Horne A, West NE. Prevalence and Risk Factors for Low Bone Mineral Density in Adults with Cystic Fibrosis. JBMR Plus 2022; 6:e10666. [DOI: 10.1002/jbm4.10666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rebecca L Boyle
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore MD USA
| | - Kevin J Psoter
- Johns Hopkins University, Division of General Pediatrics Baltimore MD USA
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore MD USA
| | - Aniket R Sidhaye
- Division of Endocrinology Johns Hopkins University Baltimore MD USA
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore MD USA
| | - Shivani Patel
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore MD USA
| | - Kristina Montemayor
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore MD USA
| | - Alexandra Horne
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore MD USA
| | - Natalie E West
- Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore MD USA
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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
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Cystic fibrosis foundation consensus statements for the care of cystic fibrosis lung transplant recipients. J Heart Lung Transplant 2021; 40:539-556. [PMID: 34103223 DOI: 10.1016/j.healun.2021.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 12/27/2022] Open
Abstract
Cystic fibrosis (CF) is the indication for transplantation in approximately 15% of recipients worldwide, and Cystic Fibrosis Lung Transplant Recipients (CFLTRs) have excellent long-term outcomes. Yet, CFLTRs have unique comorbidities that require specialized care. The objective of this document is to provide recommendations to CF and lung transplant clinicians for the management of perioperative and underlying comorbidities of CFLTRs and the impact of transplantation on these comorbidities. The Cystic Fibrosis Foundation (CFF) organized a multidisciplinary committee to develop CF Lung Transplant Clinical Care Recommendations. Three workgroups were formed to develop focused questions. Following a literature search, consensus recommendations were developed by the committee members based on literature review, committee experience and iterative revisions, and in response to public comment. The committee formulated 32 recommendation statements in the topics related to infectious disease, endocrine, gastroenterology, pharmacology, mental health and family planning. Broadly, the committee recommends close coordination of care between the lung transplant team, the cystic fibrosis care center, and specialists in other disciplines with experience in the care of CF and lung transplant recipients. These consensus statements will help lung transplant providers care for CFLTRs in order to improve post-transplant outcomes in this population.
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Shah P, Lowery E, Chaparro C, Visner G, Hempstead SE, Abraham J, Bhakta Z, Carroll M, Christon L, Danziger-Isakov L, Diamond JM, Lease E, Leonard J, Litvin M, Poole R, Vlahos F, Werchan C, Murray MA, Tallarico E, Faro A, Pilewski JM, Hachem RR. DUPLICATE: Cystic Fibrosis Foundation Consensus Statements for the Care of Cystic Fibrosis Lung Transplant Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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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]
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Hatziparasides G, Loukou I, Moustaki M, Douros K. Vitamin K and cystic fibrosis: A gordian knot that deserves our attention. Respir Med 2019; 155:36-42. [PMID: 31295676 DOI: 10.1016/j.rmed.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 01/16/2023]
Abstract
Cystic fibrosis (CF) is an inherited genetic disorder with multiorgan involvement. Gastrointestinal tract dysfunction leads to fat and fat-soluble vitamins (A,D,E,K) malabsorption and deficiency of these vitamins. Subclinical vitamin K (VK) deficiency seems to be a common problem in CF patients. However, despite the rest of fat-soluble vitamins being routinely supplemented, this is not a universal clinical practice for VK. Inefficient levels of VK may have significant effects on blood coagulation and bone formation. There are also some data indicating that VK may play a key role on regulation of inflammation. Supplementing CF patients with VK seems rational, but the appropriate dosing regimens are still a matter of debate. This review will try to delineate the problem and communicate the latest opinions on this controversial issue.
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Affiliation(s)
- Gregorios Hatziparasides
- Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, University General Hospital "Attikon", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Loukou
- Cystic Fibrosis Dept, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Moustaki
- Cystic Fibrosis Dept, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Konstantinos Douros
- Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, University General Hospital "Attikon", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Multiple prevalent fractures in relation to macroscopic bone architecture in patients with cystic fibrosis. J Cyst Fibros 2018; 17:114-120. [DOI: 10.1016/j.jcf.2016.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/31/2016] [Accepted: 06/06/2016] [Indexed: 11/20/2022]
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Chirita-Emandi A, Shepherd S, Kyriakou A, McNeilly JD, Dryden C, Corrigan D, Devenny A, Ahmed SF. A retrospective analysis of longitudinal changes in bone mineral content in cystic fibrosis. J Pediatr Endocrinol Metab 2017; 30:807-814. [PMID: 28222031 DOI: 10.1515/jpem-2016-0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 12/19/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND We aimed to describe the longitudinal changes in bone mineral content and influencing factors, in children with cystic fibrosis (CF). METHODS One hundred children (50 females) had dual X-ray absorptiometry (DXA) performed. Of these, 48 and 24 children had two to three scans, respectively over 10 years of follow-up. DXA data were expressed as lumbar spine bone mineral content standard deviation score (LSBMCSDS) adjusted for age, gender, ethnicity and bone area. Markers of disease, anthropometry and bone biochemistry were collected retrospectively. RESULTS Baseline LSBMCSDS was >0.5 SDS in 13% children, between -0.5; 0.5 SDS, in 50% and ≤-0.5 in the remainder. Seventy-eight percent of the children who had baseline LSBMCSDS >-0.5, and 35% of the children with poor baseline (LSBMCSDS<-0.5), showed decreasing values in subsequent assessments. However, mean LS BMC SDS did not show a significant decline in subsequent assessments (-0.51; -0.64; -0.56; p=0.178). Lower forced expiratory volume in 1 s percent (FEV1%) low body mass index standard deviation scores (BMI SDS) and vitamin D were associated with reduction in BMC. CONCLUSIONS Bone mineral content as assessed by DXA is sub-optimal and decreases with time in most children with CF and this study has highlighted parameters that can be addressed to improve bone health.
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Oei L, Zillikens MC, Rivadeneira F, Oei EHG. Osteoporotic Vertebral Fractures as Part of Systemic Disease. J Clin Densitom 2016; 19:70-80. [PMID: 26376171 DOI: 10.1016/j.jocd.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/13/2015] [Indexed: 12/31/2022]
Abstract
Our understanding of the genetic control of skeletogenesis and bone remodeling is expanding, and normally, bone resorption and bone formation are well balanced through regulation by hormones, growth factors, and cytokines. Osteoporosis is considered a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Consequent increased bone fragility results in higher fracture risk. The most common osteoporotic fractures are located in the spine, and they form a significant health issue. A large variety of systemic diseases are associated with risk of osteoporotic vertebral fractures, illustrating its multifactorial etiology. Prevalences of these conditions vary from common to extremely rare, and incidence peaks differ according to etiology. This review appreciates different aspects of osteoporotic vertebral fractures as part of systemic disease, including genetic, immunologic, inflammatory, metabolic, and endocrine pathways. It seems impossible to be all-comprehensive on this topic; nevertheless, we hope to provide a reasonably thorough overview. Plenty remains to be elucidated in this field, identifying even more associated diseases and further exposing pathophysiological mechanisms underlying osteoporotic vertebral fractures.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands; Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Body composition, lung function, and prevalent and progressive bone deficits among adults with cystic fibrosis. Joint Bone Spine 2015; 83:207-11. [PMID: 26677995 DOI: 10.1016/j.jbspin.2015.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/19/2015] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Cystic fibrosis (CF) is associated with osteoporosis and incident fracture. This study assessed independent predictors of baseline and 2-year changes in bone mineral density (BMD) in adults with CF. METHODS Sixty-four adult patients with CF, ages 18-57, were recruited from the Massachusetts General Hospital Cystic Fibrosis Care Center. Dual-energy X-ray absorptiometry (DXA) was performed at the spine and radius at baseline and 2 years (in 39 subjects). Estimates of fat-free mass index (FFMI) and fat mass index (FMI) were determined using height, weight, and tetrapolar bioelectric impedance analysis. All subjects completed lung spirometry within 1 month of the study visit. Linear regression models evaluated predictors of baseline BMD Z-scores and change in PA spine BMD Z-score over 2 years. Two definitions of low BMD were studied based on Z-score (≤-1.0 and ≤-2.0). RESULTS Low BMD was present in 52% of subjects. Subjects with low BMD were more likely to be male (67% vs. 32%, P=0.009), were more likely to be currently using glucocorticoids (21% vs. 0%, P<0.001), had lower percent body fat (P=0.04), and were more likely to have had a previous fracture (60% vs. 46%, P=0.007). In multivariable models, greater FFMI and height, but not greater FMI, were associated with greater BMD. In multivariable models, low forced vital capacity (FVC) and greater FMI were associated with greater loss of BMD at the PA spine over two years. CONCLUSIONS Male sex, short stature, and low lean mass are associated with low BMD in CF. Greater adiposity and lower lung function are predictors of negative change in BMD Z-score over 2 years.
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Brookes DSK, Briody JN, Munns CF, Davies PSW, Hill RJ. Cystic fibrosis-related bone disease in children: Examination of peripheral quantitative computed tomography (pQCT) data. J Cyst Fibros 2015; 14:668-77. [PMID: 25957706 DOI: 10.1016/j.jcf.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 04/02/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The investigation of skeletal health data beyond dual X-ray absorptiometry (DXA) is limited in young individuals with CF. We assessed volumetric bone mineral densities (BMD), and bone and muscle parameters using peripheral quantitative computed tomography (pQCT) in individuals with CF and controls, 7.00-17.99 years. METHODS Peripheral QCT (XCT 3000, Stratec) measurements were made in 53 individuals with CF and 53 controls. Bone mineral content (BMC), total volumetric BMD (vBMD) and cross sectional area (CSA) of the bone were measured at the 4% and 66% sites of the non-dominant tibia and radius. Additionally, trabecular vBMD and bone strength index (BSIc) were measured at the 4% sites, and cortical vBMD, muscle CSA (mCSA) and strength strain index (SSI) were measured at the 66% sites. RESULTS Pre-pubertal males with CF had greater trabecular vBMD (p=0.01) and total vBMD (p=0.00) at 4% tibia, and greater total vBMD (p=0.02) at 4% radius. Pre-pubertal females with CF had greater total vBMD at 66% tibia (p=0.02) and radius (p=0.04), and cortical vBMD (p=0.04) at the radius. At puberty, the CF cohort had less BMC at 4% tibia (males, p=0.02; females, p=0.01), and smaller mCSA at 66% tibia (males, p=0.02; females, p=0.01). Pubertal CF females had a smaller bone CSA (p=0.01) at 4% tibia, and lower bone strength (SSI) at the tibia (p=0.00) and radius (p=0.05) sites. CONCLUSIONS Bone strength parameters were not compromised prior to puberty in this CF cohort. At puberty, the bone phenotype changed for this CF cohort, showing several deficits compared to the controls. However, bone strength was adapting to the mechanical demands of the muscle. Altered bone parameters and their implications for lowered bone strength with increased age may be greatly influenced by: the CF cohort remaining smaller for age and/or a reduced bone strain, secondary to reduced muscle force.
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Affiliation(s)
- Denise S K Brookes
- The University of Queensland, Queensland Children's Medical Research Institute, Children's Nutrition Research Centre, Brisbane, Australia; The University of Queensland, School of Medicine, Brisbane, Australia.
| | | | - Craig F Munns
- The Children's Hospital at Westmead, Sydney, Australia; University of Sydney, School of Medicine, Sydney, Australia
| | - Peter S W Davies
- The University of Queensland, Queensland Children's Medical Research Institute, Children's Nutrition Research Centre, Brisbane, Australia; The University of Queensland, School of Medicine, Brisbane, Australia
| | - Rebecca J Hill
- The University of Queensland, Queensland Children's Medical Research Institute, Children's Nutrition Research Centre, Brisbane, Australia; The University of Queensland, School of Medicine, Brisbane, Australia
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Bianchi ML, Leonard MB, Bechtold S, Högler W, Mughal MZ, Schönau E, Sylvester FA, Vogiatzi M, van den Heuvel-Eibrink MM, Ward L. Bone health in children and adolescents with chronic diseases that may affect the skeleton: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:281-94. [PMID: 24656723 DOI: 10.1016/j.jocd.2014.01.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 12/11/2022]
Abstract
The aim of this Task Force was to review the use of dual-energy X-ray absorptiometry (DXA) in children and adolescents with underlying chronic diseases that pose risk factors for compromised bone health, such as inflammation, glucocorticoid therapy, or decreased mobility. The Task Force systematically analyzed more than 270 studies, with an emphasis on those published in the interval since the original 2007 Position Statements. Important developments over this period included prospective cohort studies demonstrating that DXA measures of areal bone mineral density (aBMD) predicted incident fractures and the development of robust reference data and strategies to adjust for bone size in children with growth impairment. In this report, we summarize the current literature on the relationship between DXA-based aBMD and both fracture (vertebral and non-vertebral) outcomes and non-fracture risk factors (e.g., disease characteristics, ambulatory status, and glucocorticoid exposure) in children with chronic illnesses. Most publications described the aBMD profile of children with underlying diseases, as well as the cross-sectional or longitudinal relationship between aBMD and clinically relevant non-fracture outcomes. Studies that addressed the relationship between aBMD and prevalent or incident fractures in children with chronic illnesses are now emerging. In view of these updated data, this report provides guidelines for the use of DXA-based aBMD in this setting. The initial recommendation that DXA is part of a comprehensive skeletal healthy assessment in patients with increased risk of fracture is unchanged. Although the prior guidelines recommended DXA assessment in children with chronic diseases at the time of clinical presentation with ongoing monitoring, this revised Position Statement focuses on the performance of DXA when the patient may benefit from interventions to decrease their elevated risk of a clinically significant fracture and when the DXA results will influence that management.
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Affiliation(s)
- Maria Luisa Bianchi
- Experimental Laboratory for Children's Bone Metabolism Research, Istituto Auxologico Italiano IRCCS, Milano, Italy.
| | - Mary B Leonard
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Susanne Bechtold
- Department of Pediatrics, Medical University Munich, Munich, Germany
| | - Wolfgang Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK
| | - M Zulf Mughal
- Department of Paediatric Medicine, Royal Manchester Children's Hospital, Manchester, UK
| | - Eckhart Schönau
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinik Köln, Köln, Germany
| | | | - Maria Vogiatzi
- Department of Pediatric Endocrinology, Weill Medical College of Cornell University, New York, NY, USA
| | | | - Leanne Ward
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Bianchi ML, Colombo C, Assael BM, Dubini A, Lombardo M, Quattrucci S, Bella S, Collura M, Messore B, Raia V, Poli F, Bini R, Albanese CV, De Rose V, Costantini D, Romano G, Pustorino E, Magazzù G, Bertasi S, Lucidi V, Traverso G, Coruzzo A, Grzejdziak AD. Treatment of low bone density in young people with cystic fibrosis: a multicentre, prospective, open-label observational study of calcium and calcifediol followed by a randomised placebo-controlled trial of alendronate. THE LANCET RESPIRATORY MEDICINE 2013; 1:377-85. [DOI: 10.1016/s2213-2600(13)70064-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bortezomib a safe treatment for patients with multiple myeloma and cystic fibrosis. Mediterr J Hematol Infect Dis 2012; 4:e2012035. [PMID: 22708050 PMCID: PMC3375716 DOI: 10.4084/mjhid.2012.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/02/2012] [Indexed: 12/23/2022] Open
Abstract
Introduction: Bortezomib is a proteasome inhibitor that targets myeloma cell and its bone marrow microenvironment. Intravenous Bortezomib with or without dexamethasone, is effective and well tolerated in patients with relapsed/refractory multiple myeloma (MM). Methods: We used Bortezomib without corticosteroids, to avoid the risk of lung infection reactivations due to patient’s Pseudomonas aeruginosa colonization, in a MM patient with Cystic Fibrosis. Four 21-day cycles of Bortezomib were administrated at 1.3 mg/m2 on days 1,4,8 and 11 with a 10 day rest period. Treatment response and toxicity were evaluated. Results: After four cycles of therapy the patient achieved a very good partial response (VGPR) according to the IMWG response criteria, without clinically significant side effects. Conclusions: Bortezomib can be successfully utilized for the management of this difficult disease situation.
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De Schepper J, Roggen I, Van Biervliet S, Robberecht E, Gies I, De Waele K, De Wachter E, Malfroot A, De Baets F, Toye K, Goemaere S, Louis O. Comparative bone status assessment by dual energy X-ray absorptiometry, peripheral quantitative computed tomography and quantitative ultrasound in adolescents and young adults with cystic fibrosis. J Cyst Fibros 2011; 11:119-24. [PMID: 22119452 DOI: 10.1016/j.jcf.2011.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/12/2011] [Accepted: 10/21/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Quantitative ultrasound bone sonometry (QUS) might be a promising screening method for cystic fibrosis (CF)-related bone disease, given its absence of radiation exposure, portability of the equipment and low cost.The value of axial transmission forearm QUS in detecting osteopenia in CF was therefore studied. METHODS We investigated the application of QUS in the evaluation of bone status in a group of 64 adolescents (>12 years) and young adults (<40 years) with CF in a comparison with a dual X-ray absorptiometry (DXA) of the whole body and peripheral quantitative computed tomography (pQCT) of the radius at 4% and 66% sites. RESULTS Mean (SD) Z-scores of speed of sound (SOS), whole body bone mineral content (BMC), radial trabecular bone mineral density (BMD), and radial cortical BMD were respectively -0.31 (0.78), -0.09 (1.28), 0.10 (1.16) and -0.62 (2.88). The pQCT determined bone geometry values (cortical bone area and cortical thickness) were more depressed than the BMD data. QUS had a sensitivity and specificity of respectively 0% and 96% for diagnosing osteopenia (based on a whole body BMC Z-score<-2). CONCLUSIONS QUS cannot replace DXA, but can screen out patients with normal bone mass. Further and larger studies are needed to examine if QUS may reflect other aspects than bone mass, or if it is possible to improve its sensitivity by supplementing the SOS results with clinical risk factors.
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Affiliation(s)
- Jean De Schepper
- Department of Pediatric Endocrinology, UZ Brussel, Brussels, Belgium.
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Kang J, Litmanovich D, Bankier AA, Boiselle PM, Eisenberg RL. Manifestations of Systemic Diseases on Thoracic Imaging. Curr Probl Diagn Radiol 2010; 39:247-61. [DOI: 10.1067/j.cpradiol.2009.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sermet-Gaudelus I, Castanet M, Retsch-Bogart G, Aris RM. Update on cystic fibrosis-related bone disease: a special focus on children. Paediatr Respir Rev 2009; 10:134-42. [PMID: 19651384 DOI: 10.1016/j.prrv.2009.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A high prevalence of low bone mineralization is documented in adult patients with cystic fibrosis (CF). Osteopenia is present in up to 85% of adult patients and osteoporosis in 10% to 34%. In children, study results are discordant probably because of comparisons to different control populations and corrections for bone size in growing children. Malnutrition, inflammation, vitamin D and vitamin K deficiency, altered sex hormone production, glucocorticoid therapy, and physical inactivity are well known risk factors for poor bone health. Puberty is a critical period for bone mineralization and requires a careful follow-up to achieve optimal bone peak mass. Strategies for optimizing bone health, such as monitoring bone mineral density (BMD) and providing preventive care are necessary from childhood through adolescence to minimize CF-related bone disease in adult CF patients.
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Affiliation(s)
- Isabelle Sermet-Gaudelus
- Centre de Référence et de Compétence en Mucoviscidose, Hopital Necker-Enfants Malades, INSERM U 845, Université René Descartes, Paris, France
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