Professional Documents
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Vertebral Fractures
in Adults with Cystic
Fibrosis
Aoife Lynam
Adult CF Dietitian
Wessex Adult CF Centre U.K.
Aim
• Determine prevalence of vertebral fractures
(VF)
• Describe the characteristics of those with VF
Wessex Adult CF Bone Service
• Achieve normal weight for height
• Aim to maximise fat free mass
• Adequate Calcium intake
• Weight bearing exercise
• Advice against smoking and excessive alcohol
• DEXA with IVA
• Bone turnover markers (CTX and P1NP)
• Vitamin D and PTH
• Fracture history
Vertebral Fractures
• 5 times risk of spinal fracture
• 2 times risk for hip fracture
• Thoracic vertebral fractures
– inhibit airway clearance
– ability to receive physiotherapy
– contraindicate transplant
• What do the guidelines say?
European CF Guidelines
Method
• Retrospective review of DEXA
• All Instant Vertebral Assessments (IVAs)
reviewed for VF
• VFs discussed with Consultant Rheumatologist
• Further investigations discussed with
Consultant Radiologist
• Data collected and analysed with Microsoft
Excel
Results
280 DEXA
266 IVA
95% of those who
had a DEXA
32 VF
12% of those who
had IVA
Results
• Median age of those with VF was 39 years
(IQR 21.5–51.3 years)
– 13/32 (41%) aged ≤30 years
• VF was largely silent
– 4/32 individual (13%) reported pain
• Males accounted for 69% of those with VF (p <
0.05)
• 27% pancreatic sufficient
– 16% total patient group PS
Results Continued
• BMD not a predictor of fracture risk
27%
33%
40%
Questions?
References
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Annal Epidemiology, 19(2), pp. 73–78.
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adults with cystic fibrosis: A systematic literature review with meta-analysis. Calcified
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9. Sermet-Gaudelus, I. et al., 2011. European cystic fibrosis bone mineralisation guidelines.
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