Bone mineral status in pediatric heart transplant recipients: a retrospective observational study of an "at risk" cohort
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Published on: May 26, 2021
Ritu Sachdeva1, Raksha Soora, Janet C Bryant
1Department of Pediatrics, Division of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA. sachdevaritu@uams.edu
Insights
Post-heart transplant (PHT) recipients show significant bone loss, with over half experiencing decreased bone mineral density. This bone loss is linked to fractures and avascular necrosis, necessitating careful patient monitoring.
Area of Science:
- Nephrology
- Endocrinology
- Orthopedics
Background:
- Literature assessing bone loss burden in post-heart transplant (PHT) recipients is limited.
- Bone mineral density (BMD) is crucial for assessing skeletal health in PHT patients.
- Understanding bone complications is vital for long-term PHT recipient management.
Purpose of the Study:
- To describe the bone mineral status in PHT recipients.
- To identify the prevalence of bone loss and associated complications.
- To evaluate the management strategies for bone loss in this population.
Main Methods:
- Retrospective review of medical records for PHT recipients undergoing BMD evaluation.
- Data collected: demographics, BMD, serum calcium, phosphorus, alkaline phosphatase, steroid dose, osseous complications, and management.
- Analysis of 26 PHT recipients with BMD data, a median of 3.4 years post-transplant.
Main Results:
- Bone loss (Z-score <-1) was present in 14 (53.8%) of the evaluated PHT recipients.
- Median BMD Z-scores were -0.09 for the whole body and -1.1 for the lumbar spine.
- Three patients experienced spinal fractures and/or avascular necrosis, treated with calcitriol, bisphosphonates, or vertebroplasty.
Conclusions:
- A significant proportion of PHT recipients experience bone loss.
- Bone loss in PHT recipients is associated with increased risk of fractures and avascular necrosis.
- Regular surveillance for bone loss is recommended in PHT recipients to prevent morbidity.
Abstract:
There is a paucity of literature assessing the burden of bone loss in PHT recipients. We sought to describe the bone mineral status in PHT recipients by doing a retrospective medical record review of those who underwent evaluation of BMD when clinically indicated. Data collected included patient demographics, BMD evaluations, serum calcium, phosphorus, alkaline phosphatase, cumulative steroid dose, osseous complications and their management. Of 149 PHT recipients, 26 underwent BMD evaluation. This evaluation was done at a median of 3.4 yrs after PHT. There total serum calcium, phosphorus and alkaline phosphatase were similar at transplant and BMD study. The median BMD Z-scores were: whole body -0.09 (1.5 to -5.13) and lumbar spine -1.1 (1.5 to -5.16). Bone loss (Z-score <-1) was present in 14 (53.8%). Three patients had spinal fractures and/or avascular necrosis of various bones. Treatment included calcitrol and bisphosphonates; and vertebroplasty for spinal fracture. Bone loss was present in a significant proportion of PHT recipients and may be associated with fractures and avascular necrosis. More than half of our "at risk" cohort had bone loss. Careful surveillance of these patients should be performed to prevent morbidity.
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