What is osteoporosis?
Osteoporosis, the reduced density of bones, occurs mainly in older people. But this bone thinning can also affect CF patients and make them more prone to fractures, even without trauma. Preventing osteoporosis is a vital part of the overall care of CF patients. Why do people with CF develop osteoporosis?
In CF patients, low levels of vitamin D resulting from malabsorption impair bone formation. CF patients who do not get enough exposure to sunlight, which converts vitamin D into its active form, also may be prone to osteoporosis. Accelerated bone breakdown is related to inactivity, malnutrition, and steroid use. Also, chronic lung disease may release inflammatory factors causing more rapid bone breakdown. Patients with recurrent pulmonary exacerbations are at a high risk for osteoporosis, and lung transplant recipients have an accelerated rate of bone loss related to use of immunosuppressive drugs such as corticosteroids. Men are more often affected than women, which scientists believe is related to low sex hormone levels important to bone development, and to delayed onset of puberty. Diabetes, alcohol use, and cigarette smoking may also hasten the onset of osteoporosis. How do you detect osteoporosis?
CF patients over 18 years old should be screened every other year for osteoporosis with a DEXA (Dual-energy radiograph absorptiometry) scan. Using two separate X-rays, bone density is measured at the spine, femur, or other site. DEXA scan results are reported as T-scores and Z-scores. These values tell doctors how far the bone density is from the expected normal value. A T-score of -1.0 to -2.5 indicates osteopenia (the early stage of bone weakening) and a score of less than -2.5 is osteoporosis. Patients should also have serum vitamin D levels checked yearly along with diabetes screening. | | Pulmonologists measure bone density levels in CF patients at risk of early osteoporosis. |
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How is CF osteoporosis treated?
CF osteoporosis is treated by maximizing nutritional intake, with special attention to vitamin D and calcium. Sunlight helps bone health by increasing active amounts of vitamin D. A daily exercise program is also helpful in strengthening bones. Depending on the severity of the disease, biosphosphonates may be prescribed to help encourage new bone growth. Can CF osteoporosis be prevented?
Preventing osteoporosis is very similar to the way it is treated. To reduce your risk, • Exercise to build strong bones
• Maintain good nutritional intake, especially calcium and vitamin D.
• Get adequate sunlight to help your body make the vitamin D needed to build strong bones.
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