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Factors associated with low bone mineral density in patients with cystic fibrosis

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Abstract

Osteoporosis associated with cystic fibrosis is becoming more important as the life expectancy of patients continues to improve. This study was done to determine the prevalence of osteoporosis and osteopenia in CF patients and to identify risk factors. We reviewed the medical charts of 103 adults and adolescents with Cystic Fibrosis who had undergone a dual energy X-ray absorptiometry (DEXA) scan to measure the bone mineral content of the lumbar spine (L1–L4). Disease severity was assessed by lung function and body mass index (BMI) was calculated from weight and height at the time of the DEXA. None of the patients were being treated for low BMD. Random blood samples were analyzed for biochemical markers. The relationship between all these variables and BMD measurements was analyzed. Of 103 patients, ten (9.7 %) patients (9 males, 1 female) were diagnosed with osteoporosis. An additional 36 (35 %) patients (26 males, 10 females) were identified as having osteopenia. BMI, gender, weight, lung functions (FVC, FEV1, and FEF 25–75), and alkaline phosphatase, and 25-OH vitamin D levels were significantly correlated with Z-scores (p < 0.05). Stepwise linear regression revealed that a low Z-score was best predicted with low FEV1, male gender, low weight, and low 25-OH vitamin D levels (p < 0.05) for each variable. Osteopenia and osteoporosis are common in adults with CF, especially in male patients and in patients with low lung function, body weight, and 25-OH vitamin D levels.

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Abbreviations

BMI:

Body mass index

CF:

Cystic fibrosis

DEXA:

Dual energy X-ray absorptiometry

FEV1:

Forced expiratory volume in one second

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Acknowledgments

This study was not funded by any grant.

Conflict of interest

No potential conflict of interest exists with any companies or organizations whose products and services may be discussed in this article. All authors have no conflicts of interest.

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Correspondence to Shahid Sheikh.

Appendix

Appendix

Definition of terms and criteria

Osteoporosis: A disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone loss and to an increased risk of bone fractures.

Osteopenia: Low bone mass for age; a clinically significant decrease in bone mass compared to expected values adjusted for age and gender.

WHO classification for osteoporosis:

Normal—Z-score greater than −1.0,

Osteopenia—Z-score between −1.0 and −2.49,

Osteoporosis—Z-score of −2.5 or less.

Body mass index (BMI): A ratio that indicates appropriate weight for height. Weight in kg divided by height in meters squared.

Dual energy X-ray absorptiometry (DEXA): Measures bone mineral content of regional bones and whole body (Bone mineral density gm/cm2). Results are influenced by and referenced to patient’s age, height, weight, and Tanner stage.

25-hydroxy vitamin D (25-OH vitamin D): CFF Bone Health Consensus Report (2002) recommends targeting 25-hydroxy vitamin D levels above 30 ng/ml in the CF population [9].

Z-scores: The number of standard deviations (SD) that a BMD measurement is from the mean of an age- and gender-matched control population.

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Sheikh, S., Gemma, S. & Patel, A. Factors associated with low bone mineral density in patients with cystic fibrosis. J Bone Miner Metab 33, 180–185 (2015). https://doi.org/10.1007/s00774-014-0572-z

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