Consensus statement: Guide to bone health and disease in cystic fibrosis

Cystic fibrosis (CF) is the most common genetic disease within the Caucasian population and leads to premature respiratory failure. Approximately 60,000 individuals are currently living with CF in North America and Europe, 40% of whom are adults. Thelifespanofthesepatientshasincreasedfromapproximately 2 to 32 yr of age over the last three decades. Bone disease has emerged as a common complication in long-term survivors of CF. Some studies have observed that 50–75% of adults have low bone density and increased rates of fractures. Prevention and treatment of CF-related bone disease must address the myriad risk factors (decreased absorption of fat-soluble vitamins due to pancreatic insufficiency, altered sex hormone production, chronic lung infection with increased levels of bone-active cytokines, physical inactivity, and glucocorticoid therapy) for poor bone health. This review is a condensed and updated summaryoftheGuidetoBoneHealthandDiseaseinCysticFibrosis: A Consensus Conference, a statement that evolved from a meeting convened by the Cystic Fibrosis Foundation in May 2002 to address the pathogenesis, diagnosis, and treatment of bone disease in CF. The goal of this conference was to develop practice guidelines for optimizing bone health in patients with CF. (J Clin Endocrinol Metab 90: 1888–1896, 2005)

[1]  S. Booth,et al.  Calcium kinetics are altered in clinically stable girls with cystic fibrosis. , 2004, The Journal of clinical endocrinology and metabolism.

[2]  S. Bell,et al.  Bone mineral density in Australian children, adolescents and adults with cystic fibrosis: a controlled cross sectional study , 2004, Thorax.

[3]  J. Renner,et al.  Efficacy of alendronate in adults with cystic fibrosis with low bone density. , 2004, American journal of respiratory and critical care medicine.

[4]  R. Aris,et al.  Carboxylated osteocalcin levels in cystic fibrosis. , 2003, American journal of respiratory and critical care medicine.

[5]  D. C. Backlund,et al.  Short-term calcitriol administration improves calcium homeostasis in adults with cystic fibrosis , 2003, Osteoporosis International.

[6]  J. Compston,et al.  Histomorphometric analysis of bone biopsies from the iliac crest of adults with cystic fibrosis. , 2002, American journal of respiratory and critical care medicine.

[7]  R. Baker,et al.  Consensus Report on Nutrition for Pediatric Patients With Cystic Fibrosis , 2002, Journal of pediatric gastroenterology and nutrition.

[8]  J. Adams,et al.  A prospective study of change in bone mineral density over one year in adults with cystic fibrosis , 2002, Thorax.

[9]  R. Speich,et al.  Osteoporosis Before Lung Transplantation: Association with Low Body Mass Index, but Not with Underlying Disease , 2002, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[10]  J. Renner,et al.  Abnormal Bone Turnover in Cystic Fibrosis Adults , 2002, Osteoporosis International.

[11]  J. Rice,et al.  Growth hormone improves clinical status in prepubertal children with cystic fibrosis: results of a randomized controlled trial. , 2001, The Journal of pediatrics.

[12]  J. Rice,et al.  Growth hormone decreases protein catabolism in children with cystic fibrosis. , 2001, The Journal of clinical endocrinology and metabolism.

[13]  M. Corey,et al.  Treatment of vitamin K deficiency in cystic fibrosis: Effectiveness of a daily fat-soluble vitamin combination. , 2001, The Journal of pediatrics.

[14]  J. Adams,et al.  Bone status in cystic fibrosis , 2001, Archives of disease in childhood.

[15]  J. Adams,et al.  Effect of intravenous pamidronate on bone mineral density in adults with cystic fibrosis , 2001, Thorax.

[16]  K. Ellis,et al.  Normal bone mineral density in cystic fibrosis , 2001, Archives of disease in childhood.

[17]  B. Hollis,et al.  Diminished and erratic absorption of ergocalciferol in adult cystic fibrosis patients. , 2001, The American journal of clinical nutrition.

[18]  L. Bachrach Acquisition of optimal bone mass in childhood and adolescence , 2001, Trends in Endocrinology & Metabolism.

[19]  J. Compston,et al.  Vertebral Deformities and Low Bone Mineral Density in Adults with Cystic Fibrosis: A Cross-sectional Study , 2001, Osteoporosis International.

[20]  H. White,et al.  Osteoporosis and osteopenia in adults and adolescents with cystic fibrosis: prevalence and associated factors , 2000, Thorax.

[21]  J. Renner,et al.  Efficacy of pamidronate for osteoporosis in patients with cystic fibrosis following lung transplantation. , 2000, American journal of respiratory and critical care medicine.

[22]  P. Hasleton,et al.  Bone histomorphometry in adult patients with cystic fibrosis. , 2000, Chest.

[23]  G. Chan,et al.  Bone mineral status in prepubertal children with cystic fibrosis. , 2000, The Journal of pediatrics.

[24]  A. Spira,et al.  Osteoporosis and lung transplantation: a prospective study. , 2000, Chest.

[25]  R. Lark,et al.  Adverse alterations in bone metabolism are associated with lung infection in adults with cystic fibrosis. , 2000, American journal of respiratory and critical care medicine.

[26]  J. Adams,et al.  Low bone mineral density in adults with cystic fibrosis , 1999, Thorax.

[27]  H. McKay,et al.  A Six‐Year Longitudinal Study of the Relationship of Physical Activity to Bone Mineral Accrual in Growing Children: The University of Saskatchewan Bone Mineral Accrual Study , 1999, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[28]  S. Butler,et al.  Patterns of medical practice in cystic fibrosis: Part II. Use of therapies , 1999, Pediatric pulmonology.

[29]  E. M. Laursen,et al.  Bone mineral status in 134 patients with cystic fibrosis , 1999, Archives of disease in childhood.

[30]  E. Shane,et al.  Bone loss and fracture after lung transplantation. , 1999, Transplantation.

[31]  C. Madsen,et al.  Bone mineral content and body composition in children and young adults with cystic fibrosis , 1999, Pediatric pulmonology.

[32]  C. Haworth,et al.  Severe bone pain after intravenous pamidronate in adult patients with cystic fibrosis , 1998, The Lancet.

[33]  F. Kainberger,et al.  High turnover bone disease following lung transplantation. , 1998, Bone.

[34]  E. Shane,et al.  Osteoporosis after organ transplantation. , 1998, The American journal of medicine.

[35]  S. Ott,et al.  Osteoporosis in patients with cystic fibrosis. , 1998, Clinics in chest medicine.

[36]  C. Gottlieb,et al.  Female patients with cystic fibrosis suffer from reproductive endocrinological disorders despite good clinical status. , 1998, Human reproduction.

[37]  R. Marcus,et al.  Bone acquisition and loss in children and adults with cystic fibrosis: a longitudinal study. , 1998, The Journal of pediatrics.

[38]  R. Lindsay,et al.  Bone mass and vitamin D deficiency in adults with advanced cystic fibrosis lung disease. , 1998, American journal of respiratory and critical care medicine.

[39]  K. Gaskin,et al.  Volumetric bone mineral density in children with cystic fibrosis. , 1998, Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine.

[40]  J. Renner,et al.  Increased Rate of Fractures and Severe Kyphosis: Sequelae of Living into Adulthood with Cystic Fibrosis , 1998, Annals of Internal Medicine.

[41]  Y. Ouchi,et al.  Osteoporosis in lung transplantation candidates with end-stage pulmonary disease. , 1997, The American journal of medicine.

[42]  J. Bai,et al.  Bone mineral density in patients with pancreatic insufficiency and steatorrhea. , 1997, The American journal of gastroenterology.

[43]  G. Saggese,et al.  Bone Demineralization in Cystic Fibrosis: Evidence of Imbalance between Bone Formation and Degradation , 1997, Pediatric Research.

[44]  R. Rizzoli,et al.  Osteoporosis in patients undergoing lung transplantation. , 1996, The European respiratory journal.

[45]  T. Egan,et al.  Severe osteoporosis before and after lung transplantation. , 1996, Chest.

[46]  D. Thiebaud,et al.  Bone mineral content in cystic fibrosis patients: correlation with fat-free mass. , 1996, Archives of disease in childhood.

[47]  S. Boas,et al.  Salivary testosterone levels in male adolescents with cystic fibrosis. , 1996, Pediatrics.

[48]  R. Marcus,et al.  Correlates of osteopenia in patients with cystic fibrosis. , 1996, Pediatrics.

[49]  C. Madsen,et al.  Bone density in children and adolescents with cystic fibrosis. , 1996, The Journal of pediatrics.

[50]  R. Jilka,et al.  Bone marrow, cytokines, and bone remodeling. Emerging insights into the pathophysiology of osteoporosis. , 1995, The New England journal of medicine.

[51]  C. Pichard,et al.  Body composition analysis by dual-energy x-ray absorptiometry in adults with cystic fibrosis. , 1994, Chest.

[52]  R. Henderson,et al.  Kyphosis and fractures in children and young adults with cystic fibrosis. , 1994, The Journal of pediatrics.

[53]  R. Marcus,et al.  Osteopenia in adults with cystic fibrosis , 1994 .

[54]  I. Reid,et al.  Bone mineral density and body composition in adult patients with cystic fibrosis. , 1993, Thorax.

[55]  M. Jonckheer,et al.  Low serum bone gamma-carboxyglutamic acid protein concentrations in patients with cystic fibrosis: correlation with hormonal parameters and bone mineral density. , 1993, Hormone research.

[56]  R. Stern,et al.  Weight and menstrual function in patients with eating disorders and cystic fibrosis. , 1990, Pediatrics.

[57]  M. Boechat,et al.  Osteoporosis in cystic fibrosis. , 1988, The Journal of pediatrics.

[58]  M. Hodson,et al.  AMENORRHOEA IN CYSTIC FIBROSIS , 1987, Clinical endocrinology.

[59]  M. McKenna,et al.  Hypovitaminosis D and response to supplementation in older patients with cystic fibrosis. , 1985, The Quarterly journal of medicine.

[60]  M. Pitt,et al.  Kyphosis and Pulmonary Function in Cystic Fibrosis , 1984, Clinical pediatrics.

[61]  R. Rosenfeld,et al.  Short stature and pubertal delay in male adolescents with cystic fibrosis. Androgen treatment. , 1984, American journal of diseases of children.

[62]  P. Gaerlan,et al.  Thoracic kyphosis in cystic fibrosis. , 1981, Clinical orthopaedics and related research.

[63]  D. Holsclaw,et al.  Menarchal determinants in cystic fibrosis. , 1980, American journal of diseases of children.

[64]  T. Hahn,et al.  Reduced serum 25-hydroxyvitamin D concentration and disordered mineral metabolism in patients with cystic fibrosis. , 1979, The Journal of pediatrics.

[65]  W. Warwick,et al.  Spine deformities and cystic fibrosis. , 1978, Clinical orthopaedics and related research.

[66]  L. Avioli,et al.  Effects of diabetes mellitus on bone mass in juvenile and adult-onset diabetes. , 1976, The New England journal of medicine.