Osteoporosis and osteopenia in adults and adolescents with cystic fibrosis: prevalence and associated factors

Thorax. 2000 Sep;55(9):798-804. doi: 10.1136/thorax.55.9.798.

Abstract

Background: Patients with cystic fibrosis (CF) have many risk factors for reduced bone mineral density (BMD). The aim of this study was to determine the prevalence of osteoporosis and osteopenia in a large cross section of patients and to identify risk factors.

Methods: All patients attending the regional centre were invited to participate in the study. Bone mineral density was measured at the lumbar spine, femoral neck, and for total body with a Lunar DPX-L densitometer. Multiple indices of disease severity were investigated, and liver and thyroid function, blood calcium, phosphate, 25-OH vitamin D, follicle stimulating and luteinising hormone, oestradiol, and testosterone levels were measured. Patients completed a four day prospective dietary diary. Exercise was assessed by a seven day activity recall questionnaire. Sexual development and treatment histories were obtained. The relationship between all these variables and BMD measurements was analysed.

Results: Sixty six percent of 114 patients assessed had osteopenia or osteoporosis. The Shwachman-Kulczycki (SK) clinical score (higher score = less severe disease) correlated significantly with BMD at the lumbar spine and femoral neck, and with total body BMD (p<0.001). There was a predicted increase of 0.0032 g/cm(2) in lumbar spine BMD for every unit increase in the SK score. Oral steroid use was significantly associated with reduced BMD at the lumbar spine (p = 0.017) and femoral neck (p = 0.027).

Conclusions: Osteopenia and osteoporosis are common findings in a heterogeneous population of adults with CF. Patients at most risk are those with severe disease and those who have used corticosteroids.

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Bone Density / physiology*
  • Bone Diseases, Metabolic / complications*
  • Bone Diseases, Metabolic / epidemiology
  • Bone Diseases, Metabolic / physiopathology
  • Cystic Fibrosis / complications*
  • Cystic Fibrosis / physiopathology
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Male
  • Osteoporosis / complications
  • Osteoporosis / epidemiology
  • Osteoporosis / physiopathology
  • Prevalence
  • Risk Factors
  • Statistics, Nonparametric
  • Vital Capacity / physiology