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Correlates of osteopenia in patients with cystic fibrosis
G S Bhudhikanok1, J Lim, R Marcus
1Department of Pediatrics, Stanford University School of Medicine, California, USA.
Insights
Osteopenia is common in cystic fibrosis patients of all ages. Several clinical factors contribute to low bone mineral density, impacting bone health in this growing population.
Area of Science:
- Medical Research
- Bone Metabolism
- Pediatric Health
Background:
- Improved survival in cystic fibrosis (CF) leads to increased prevalence of chronic complications.
- Bone health is a significant concern for individuals with CF, impacting quality of life and long-term outcomes.
Purpose of the Study:
- To determine the prevalence of osteopenia in pediatric and adult patients with cystic fibrosis.
- To identify clinical risk factors associated with diminished bone mineral density in CF patients.
Main Methods:
- Compared bone mineral levels in 49 CF patients (ages 8-48) with age- and sex-matched controls.
- Measured bone mineral at lumbar spine, femoral neck, and whole body using dual-energy radiographic absorptiometry.
- Evaluated clinical variables including age, body mass, illness severity, and medication use as potential correlates of bone mineral status.
Main Results:
- CF patients exhibited significantly lower bone mineral at all measured sites compared to controls.
- Osteopenia was prevalent, with 26 of 49 patients showing low bone mineral density (BMD) z scores.
- Factors like age, pubertal stage, body mass, illness severity, glucocorticoid use, and gonadal function predicted bone mineral status.
Conclusions:
- Osteopenia is a common complication across all age groups in cystic fibrosis.
- Both inadequate bone mineral accrual and increased bone loss likely contribute to bone density deficits in CF.
- Several clinical factors are implicated in the development of reduced bone mineral in individuals with CF.
Objective:
As the expected survival improves for individuals with cystic fibrosis, these individuals face myriad medical complications. The goals of this study were to examine the prevalence of osteopenia in children and adults with cystic fibrosis and to elucidate the risk factors associated with deficits in bone mineral.
Methodology:
We compared bone mineral levels in 49 patients (30 female and 19 male) ages 8 through 48 years with those of age- and sex-matched control subjects. Lumbar spine, femoral neck, and whole-body bone mineral were measured by dual-energy radiographic absorptiometry and expressed in terms of bone mineral content, areal bone density (BMD), and bone mineral apparent density (BMAD), which corrects for differences in bone size. Clinical variables were evaluated as potential correlates of bone mineral.
Results:
Patients with cystic fibrosis had significantly less bone mineral than did control subjects at all sites using all expressions of bone mass. Mean BMD z scores were -1.7 (lumbar spine), -1.9 (femoral neck), and -1.2 (whole body). BMAD z scores also were significantly low for age and gender. Twenty-six of the 49 patients (8 adolescents) had significant osteopenia according to their BMD z scores; 14 of the 45 patients (5 adolescents) with available BMAD z scores had significantly low values at one or more sites. Age, pubertal stage, body mass, caloric expenditure, illness severity, glucocorticoid therapy, and gonadal function predicted bone mineral status. Serum parathyroid hormone and calcium, carbohydrate intake, and weight-bearing activity had limited predictive value. Daily calcium intake and cystic fibrosis transmembrane regulator genotype did not predict bone mineral status.
Conclusions:
Osteopenia is common at all ages in cystic fibrosis, suggesting that inadequate bone mineral accretion as well as increased bone loss contribute to the deficits in bone mineral observed. Several clinical factors seem to contribute to these deficits.