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a Adult Cystic
Fibrosis Unit, Wythenshawe Hospital, Manchester M23 9LT, UK, b Department of Medicine, University of
Manchester, Manchester Royal Infirmary, Manchester M13 9WL, UK, c Osteoarticular Pathology, Correspondence to: Dr A K Webb.
Received 4 January
1999; Returned to authors 10 March 1999; Revised version received 21 June 1999;
Accepted for publication 24 June 1999
BACKGROUND
Patients
with cystic fibrosis have several risk factors for the development of
low bone mineral density (BMD). To identify the prevalence and clinical
correlates of low BMD in adult patients with cystic fibrosis,
densitometry was performed in 151 patients (83 men) aged
15-52 years.
METHODSBMD was
measured in the lumbar spine (L1-4) using dual energy
x ray absorptiometry (DXA) and quantitative
computed tomography (QCT). It was also measured in the proximal femur
(total hip and femoral neck) using DXA, and in the distal and ultra
distal forearm using single energy x ray
absorptiometry (SXA). Biochemical markers of bone turnover, vitamin D
levels, parathyroid hormone levels, and a variety of anthropometric
variables were also assessed.
RESULTSThe mean
(SD) BMD Z score was -0.73 (0.85) in the distal forearm, -0.31 (0.92)
in the ultra distal forearm, -1.21 (1.18) in the lumbar spine using
DXA, -0.56 (1.36) in the lumbar spine using QCT, -1.25 (1.30) in the
femoral neck, and -1.01 (1.14) in the total hip. 34% of patients had
a BMD Z score of -2 or less at one or more skeletal sites. Body mass
index (0.527, p = 0.01), percentage predicted forced expiratory volume
in one second (0.388, p = 0.01), and physical activity (0.249, p = 0.05) were positively related to the mean BMD Z score. Levels of C
reactive protein (-0.328, p = 0.01), parathyroid hormone (-0.311, p = 0.01) and biochemical markers of bone turnover (osteocalcin -0.261
and bone specific alkaline phosphatase -0.249, p = 0.05) were
negatively related to the mean BMD Z score. Vitamin D insufficiency
(25-hydroxyvitamin D <15 ng/ml) was prevalent (53/139 patients, 38%)
despite supplementation with 900 IU vitamin D per day.
CONCLUSIONSLow bone
density is prevalent in adult patients with cystic fibrosis. Current
levels of vitamin D supplementation appear to be inadequate.
Keywords:
cystic fibrosis;
bone mineral density;
osteoporosis;
vitamin D insufficiency
© 1999 by Thorax
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