The prevalence of osteopenia and osteoporosis after heart transplantation assessed using CT
S Roest1, R P J Budde2, D A Hesselink3
1Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Osteopenia and osteoporosis are common long-term after heart transplantation (HT). Recipient age and prednisolone use are key risk factors for abnormal bone density (BD) in these patients.
Area of Science:
- Cardiology
- Endocrinology
- Radiology
Background:
- Osteoporosis is a known complication after heart transplantation (HT).
- Long-term prevalence and risk factors for abnormal bone density (BD) post-HT remain unclear.
- Previous studies primarily used dual-energy X-ray absorptiometry for BD assessment.
Purpose of the Study:
- To investigate bone mineral density (BD) using coronary computed tomography (CCT) long-term after heart transplantation (HT).
- To determine the prevalence of osteopenia and osteoporosis in patients long-term post-HT.
- To identify risk factors associated with abnormal BD in this population.
Main Methods:
- Utilized first CCT scans from February 2018 to June 2020 for annual cardiac allograft vasculopathy screening.
- Excluded retransplantations and scans with incomplete vertebral imaging.
- Measured BD as the mean of three consecutive thoracic vertebrae, categorizing into normal, osteopenia, or osteoporosis. Employed logistic and linear regression to identify determinants of abnormal BD and mean Hounsfield unit (HU) values.
Main Results:
- Included 140 patients (median age 55.2 years, 36% female) with a median of 11.0 years post-HT.
- Identified normal BD in 57%, osteopenia in 31%, and osteoporosis in 12% of patients.
- Recipient age (OR 1.10) and prednisolone use (OR 3.75) were significant determinants for abnormal BD. Left ventricular assist device use pre-HT and time since HT were also associated with BD.
Conclusions:
- Osteopenia and osteoporosis are prevalent findings on CCT scans long-term after heart transplantation (HT).
- Recipient age and corticosteroid use are significant risk factors for reduced bone density.
- Further research is needed to establish effective strategies for maintaining normal bone density in heart transplant recipients.
Objective:
Osteoporosis is frequently observed in patients after heart transplantation (HT), although the prevalence long-term post-HT is unknown. Most studies investigating bone mineral density (BD) after HT were performed using dual-energy X-ray absorptiometry. In this study BD, including the prevalence of osteopenia and osteoporosis, was investigated using coronary computed tomography (CCT) long-term post-HT. Moreover, risk factors for abnormal BD were investigated.
Methods:
All first CCT scans between February 2018 and June 2020 used for the annual screening for cardiac allograft vasculopathy were included. Retransplantations and scans with not fully imaged vertebrae were excluded. BD was measured as a mean of the BD of three consecutive thoracic vertebrae and categorized into normal BD, osteopenia or osteoporosis. Binary logistic regression was used to find determinants for an abnormal BD. Linear regression was used to explore determinants for the mean Hounsfield unit (HU) value of the BD.
Results:
In total, 140 patients were included (median age 55.2 [42.9-64.9] years, 51 (36%) female). Time between HT and CT scan was 11.0 [7.3-16.1] years. In total, 80 (57%), 43 (31%), and 17 (12%) patients had a normal BD, osteopenia, or osteoporosis, respectively. Osteoporotic fracture or vertebrae fractures was seen in 11 (8%) patients. Determinants for an abnormal BD were recipient age (OR 1.10 (1.06-1.14), p<0.001) and prednisolone use (OR 3.75 (1.27-11.01), p=0.016). In linear regression, left ventricular assist device use pre-HT (p=0.024) and time since HT (p=0.046) were additional BD determinants.
Discussion:
Osteopenia and osteoporosis are frequently seen on CCT post-HT. More investigation on appropriate measures to maintain a normal BD in these patients are needed.
More Related Videos
06:59Author Spotlight: An Economic and Efficient Method for Quantitative Evaluation of Bone Microarchitecture in a Murine Osteoporosis Model
Published on: September 8, 2023
10:31Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model
Published on: August 13, 2017
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT