Increased risk of mortality in lung transplant patients with fragility fractures

Osteoporosis and fragility fractures are frequent complications of lung transplantation patients. Among 131 patients included, 35 (26.5%) patients had a diagnosis of fractures after transplantation. Low bone mineral density was associated with fractures. Fractures post transplantation were identified as an independent risk factor for overall mortality.

The prevalence of osteoporosis among lung transplant candidates has been estimated at 31% to 46%, and significant bone loss occurs after lung transplantation, predominantly in the first year, with increased risk of incident fractures. This study aimed to evaluate the prevalence of fragility fractures in a population of lung transplant recipients and the associated risk factors as well as mortality after a fragility fracture.

This was a cross-sectional monocentric study that included patients with lung transplantation occurring < 10 years and > 1 year who were undergoing lung transplantation monitoring. All patients underwent bone mineral density evaluation by dual-energy X-ray absorptiometry and radiography to establish the presence of vertebral fractures. Mortality was assessed 2 years after the last inclusion.

We included 131 patients (82 men, 62.6%), with mean age 56.8 ± 10.8 years. The mean time from lung transplantation to inclusion was 3.5 ± 3.5 years. Overall, 35 (26.5%) patients had a diagnosis of fractures after transplantation; 67 fractures were confirmed (average of 2 per patient), including 48 (71.6%) vertebral fractures. Odds of low bone mineral density at the femoral neck, total hip and spine was associated with fracture: odds ratio 0.007 [0.0002-0.3], 0.001 [0.0002-0.05], and 0.03 [0.001-0.6], respectively. Fracture post transplantation was significantly associated with death (hazard ratio 2.32 [1.01-5.33]).

This study confirmed a high prevalence of vertebral fracture in lung transplant patients. Fracture after lung transplant was associated with mortality. Bone fragility needs more attention to reduce the fracture risk.