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a Adult Cystic
Fibrosis Unit, Seacroft Hospital, Leeds LS14 6UH, UK, b Department of Radiology, c Centre for Bone and Body Composition Research,
The General Infirmary, Leeds, UK
Correspondence to: Dr S P Conway email: steven.conway{at}gw.sjsuh.northy.nhs.uk
Received 26 October 1999; Returned to authors 20 January 2000; Revised version received 30 May 2000; Accepted for publication 7 June 2000
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.
METHODSAll 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.
RESULTSSixty 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/cm2 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).
CONCLUSIONSOsteopenia
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.
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