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(Chest. 2006;130:539-544.)
© 2006 American College of Chest Physicians

Prevalence of Vertebral Fractures in Adults With Cystic Fibrosis and Their Relationship to Bone Mineral Density*

Anne Stephenson, MD; Sophie Jamal, MD; Timothy Dowdell, MD; Dawn Pearce, MD; Mary Corey, PhD and Elizabeth Tullis, MD, FCCP

* From the Department of Respirology (Drs. Stephenson and Tullis), Adult CF Centre, the Departments of Endocrinology (Dr. Jamal) and Radiology (Drs. Dowdell and Pearce), St. Michael’s Hospital, and the Research Institute (Dr. Corey), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Correspondence to: Anne Stephenson, MD, St. Michael’s Hospital, Respirology, 30 Bond St, 6th Floor, Bond Wing, Toronto, ON, M5B 1W8 Canada; e-mail: stephensona{at}smh.toronto.on.ca

Abstract

Study objectives: The objectives of this study were to determine the prevalence of morphometric vertebral fractures in a large cohort of adult cystic fibrosis (CF) patients, and to examine the association between fractures and bone mineral density (BMD).

Design: Cross-sectional retrospective study.

Setting: A tertiary care academic hospital.

Patients: Adult CF patients who had undergone BMD testing and chest radiography within 1 month of each other.

Measurements and results: BMD was measured by dual-energy x-ray absorptiometry (DXA) at the lumbar spine (LS) and femoral neck (FN). Vertebral fractures were diagnosed using lateral chest radiographs. Several clinical and biochemical variables were assessed as correlates. Sixty subjects (36%) had z scores between –1.0 and –2.5, and 15 subjects (9%) had z scores of < –2.5. Twelve patients (7.2%) had 19 morphometric fractures. The mean BMD at the LS was 1.266 g/cm2 in the fracture group and 1.112 g/cm2 in the nonfracture group (p = 0.0002). The mean BMD at the FN was 1.129 g/cm2 in the fracture group and 0.987 g/cm2 in the nonfracture group (p = 0.0006). Both FEV1 and body mass index were significantly associated with BMD at both the LS and the FN.

Conclusion: Seven percent of adult patients with CF had vertebral fractures as determined by morphometry. Subjects in the fracture group had both clinically and statistically higher BMD as measured by DXA. Our findings raise the intriguing possibility that BMD may not be useful in identifying CF patients with fractures.

Key Words: adults • bone densitometry • cystic fibrosis • osteoporosis • vertebral fractures






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