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Idiopathic pulmonary fibrosis a rare disease with severe bone fragility

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Abstract

Idiopathic pulmonary fibrosis (IPF) is a rare form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. The aim of this cross-sectional study was to assess the prevalence of osteoporosis and fragility fracture in a population of adults with IPF and to identify whether any possible clinical and pulmonary function parameters may be associated with increased bone fragility. In 58 IPF patients (mean age 65.1 ± 9.1 years), we measured bone mineral density (BMD) of the lumbar spine, the femoral neck, and the entire hip. Moreover, the presence of vertebral fractures on a lateral chest X-ray study was evaluated, and a vertebral fracture burden was quantified using the spinal deformity index (SDI). As expected, osteoporosis was significantly more frequent in females with respect to males (57.9 vs 20.5 %, respectively), whereas the fractures prevailed in males with respect to females (38.5 vs 26.3 %, respectively). There were positive correlations between BMD at all skeletal sites and respiratory parameters; in particular for FVC % and DLCO % with BMD at femoral sub-regions. Moreover, we compared the average of DLCO (%) measure by values of SDI score that was higher in those patients with lower values of DLCO (%). The study shows a high prevalence of fragility with vertebral fractures in IPF patients, especially in males. Moreover, the vertebral fracture burden is associated with a worsening of FVC (%) and DLCO (%). Therefore, an evaluation of bone status is recommended, especially in those patients who are candidates for lung transplantation.

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Author notes

    Authors and Affiliations

    1. UOC Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy

      Carla Caffarelli, Stefano Gonnelli, Maria Dea Tomai Pitinca, Valentina Francolini & Ranuccio Nuti

    2. UOC Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy

      Annalisa Fui, Elena Bargagli, Rosa Metella Refini, David Bennett & Paola Rottoli

    Authors
    1. Carla Caffarelli
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    2. Stefano Gonnelli
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    3. Maria Dea Tomai Pitinca
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    4. Valentina Francolini
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    Correspondence to Carla Caffarelli.

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    Conflict of interest

    Carla Caffarelli, Stefano Gonnelli, Maria Dea Tomai Pitinca, Valentina Francolini, Annalisa Fui, Elena Bargagli, Rosa Metella Refini, David Bennett, Ranuccio Nuti, and Paola Rottoli declare that they have no conflict of interest.

    Statement of human and animal rights

    All procedure performed in this study were in accordance with ethical standards of the 1964 Helsinki declaration and its later amendments. Our article does not contain any studies with human and animals performed by any of the authors.

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    Informed consent was obtained from all individual participants included in the study.

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    C. Caffarelli and S. Gonnelli contributed equally to the study.

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    Caffarelli, C., Gonnelli, S., Tomai Pitinca, M.D. et al. Idiopathic pulmonary fibrosis a rare disease with severe bone fragility. Intern Emerg Med 11, 1087–1094 (2016). https://doi.org/10.1007/s11739-016-1501-z

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    • DOI: https://doi.org/10.1007/s11739-016-1501-z

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