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More Attention Should Be Paid to Bone Status Of Cystic Fibrosis Patients: Presented at WCO

By Adrian Burton
Special to DG News

LISBON, PORTUGAL -- May 13, 2002 -- Earlier bone evaluation could lead to better prevention of osteoporosis in cystic fibrosis patients.

However, patients with cystic fibrosis appear to have difficulties with absorption of calcium and vitamin D supplementation and may require intramuscular administration.

So say Swiss researchers who presented results showing that low bone mineral density (BMD) is a complication of cystic fibrosis in young adults and even in younger patients, yet checking for this problem is not always common.

"In our study we found that many patients had never had a bone density evaluation," said Isabelle Pache MD, Physician in the Dept. of Osteology, University Hospital of Lausanne, Switzerland, speaking here yesterday at the International Osteoporosis Federation's International Congress on Osteoporosis.

Dr. Pache's team evaluated BMD in 25 patients with cystic fibrosis who had stable disease or were on a waiting list for lung transplants, to see how their condition related to body mass index (BMI), 25-OH-vitamin D levels and calcium and vitamin D supplementation.

The mean age of first densitometry was 26.4±5.8 years. Twelve patients had osteoporosis and eight had osteopenia at more than one site. Five patients (20 percent) had a normal BMD. Of the eight patients waiting for lung transplants, seven had osteoporosis and one had osteopenia. The lumbar spine and femoral neck were the sites where low BMD values were most frequently found (90 percent and 85 percent respectively).

Patients with low BMI had a significantly lower BMD (p=0.04), "This has to do with low fat levels and protein undernutrition," said Dr. Pache.

All patients had similar calcemia, phosphatemia and alkaline phosphatase levels; 78.6 percent showed vitamin D levels under25 mmol/L. Half of the patients with low BMI had been placed on calcium and vitamin D supplementation before their bone evaluation, but this seemed to have no effect on serum vitamin D if less than 800 IU vitamin D were taken via the oral route.

"Very few people were receiving supplementation, even though they were known to have bone problems. But even in those who were treated, the level of serum vitamin D was no higher than in those who were not. There seems to be some problem of absorption."

The team concluded that it is time to pay more attention to the bone problems of cystic fibrosis patients. BMD should be estimated much earlier and calcium and vitamin D supplementation taken more seriously. "However, it seems that if we are to get vitamin D levels up in these types of patient, it is going to have to be given intramuscularly or in some other way," concluded Dr. Pache.

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