TY - JOUR
T1 - Fracture after cardiac transplantation
T2 - A prospective longitudinal study
AU - Shane, Elizabeth
AU - Rivas, Maria
AU - Staron, Ronald B.
AU - Silverberg, Shonni J.
AU - Seibel, Markus J.
AU - Kuiper, Jan
AU - Mancini, Donna
AU - Addesso, Vicki
AU - Michler, R. E.
AU - Factor-Litvak, P.
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1996
Y1 - 1996
N2 - Cardiac transplantation is associated with increased prevalence of vertebral fractures, but the natural history of and risk factors for fracture after this life-saving procedure are unclear. We evaluated 47 patients (34 men and 13 postmenopausal women) before transplantation with spinal radiographs, determination of bone density by dual energy x-ray absorptiometry, and measurement of biochemical indexes of mineral metabolism. During the first year after transplantation, incident fractures were documented radiographically. Associations among demographic characteristics, bone density, biochemistries, and fracture risk were evaluated with logistic regression analysis. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), 17 patients (7 women and 10 men) sustained a total of 34 fractures. Most fractures involved the spine, and 85% of the patients who experienced fracture did so within 6 months of transplantation. Fifty-four percent of the women and 29% of the men experienced fracture. Femoral neck bone mineral density was significantly lower in women who experienced fracture than in those who did not (0.604 ± 0.11 vs. 0.760 ± 0.12 g/cm2; P < 0.04), but did not differ in men according to fracture outcome. The amount of bone loss at the femoral neck by 6 months after transplantation was significantly greater in men with fracture than in men without fracture (12.0 ± 6.4% vs. 6.8 ± 5.3%; P < 0.04), but did not differ in women according to fracture outcome. Pretransplant 1,25- dihydroxyvitamin D levels were significantly lower (25 ± 9 vs. 39 ± 17 pg/mL; P < 0.007) and intact PTH levels tended to be higher in men who did not experience fracture (37 ± 15 vs. 69 ± 46 pg/mL; P < 0.06). Individual pretransplant bone density measurements demonstrated substantial overlap between patients who did and did not experience fracture, and normal bone density did not necessarily protect against fracture after transplantation. We conclude that fractures are a common and early complication of cardiac transplantation. No pretransplant measurement has yet been identified that reliably predicts fracture after transplantation in the individual patient.
AB - Cardiac transplantation is associated with increased prevalence of vertebral fractures, but the natural history of and risk factors for fracture after this life-saving procedure are unclear. We evaluated 47 patients (34 men and 13 postmenopausal women) before transplantation with spinal radiographs, determination of bone density by dual energy x-ray absorptiometry, and measurement of biochemical indexes of mineral metabolism. During the first year after transplantation, incident fractures were documented radiographically. Associations among demographic characteristics, bone density, biochemistries, and fracture risk were evaluated with logistic regression analysis. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), 17 patients (7 women and 10 men) sustained a total of 34 fractures. Most fractures involved the spine, and 85% of the patients who experienced fracture did so within 6 months of transplantation. Fifty-four percent of the women and 29% of the men experienced fracture. Femoral neck bone mineral density was significantly lower in women who experienced fracture than in those who did not (0.604 ± 0.11 vs. 0.760 ± 0.12 g/cm2; P < 0.04), but did not differ in men according to fracture outcome. The amount of bone loss at the femoral neck by 6 months after transplantation was significantly greater in men with fracture than in men without fracture (12.0 ± 6.4% vs. 6.8 ± 5.3%; P < 0.04), but did not differ in women according to fracture outcome. Pretransplant 1,25- dihydroxyvitamin D levels were significantly lower (25 ± 9 vs. 39 ± 17 pg/mL; P < 0.007) and intact PTH levels tended to be higher in men who did not experience fracture (37 ± 15 vs. 69 ± 46 pg/mL; P < 0.06). Individual pretransplant bone density measurements demonstrated substantial overlap between patients who did and did not experience fracture, and normal bone density did not necessarily protect against fracture after transplantation. We conclude that fractures are a common and early complication of cardiac transplantation. No pretransplant measurement has yet been identified that reliably predicts fracture after transplantation in the individual patient.
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U2 - 10.1210/jc.81.5.1740
DO - 10.1210/jc.81.5.1740
M3 - Article
C2 - 8626827
AN - SCOPUS:9344258565
SN - 0021-972X
VL - 81
SP - 1740
EP - 1746
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 5
ER -