FRI677 Analysis Of Characteristics Associated With Osteoporosis In Solid Organ Transplant Recipients - Results Of Phoenix VA Based Quality Improvement Project
Authors: Shah Tanvi , Vinales Karyne 
Published: October 2023

Abstract
Disclosure: T. Shah: None. K. Vinales: None.
Introduction: Solid organ transplants are increasingly performed for multiple end-stage organ failures, that increase longevity and quality of life, but can be complicated with osteoporosis, which is associated with increased morbidity and mortality. Determining the risk factors, diagnostic and treatment related characteristics will facilitate improvement in care of patients with this condition. Design: This was part of a quality improvement project at single institution to identify male veterans, 65 years and older, who were at risk for or osteoporosis. In this analysis, we focused on those with solid-organ transplant who developed post-transplant osteoporosis over the past 10 years. Various parameters were obtained, along with the most recent DXA scan, quantifying the T-scores at various sites, trabecular bone score (TBS) and treatment modalities. Results: From initial cohort of male veterans at risk for osteoporosis (n=1676), 26 (1.5%) were identified as post-transplant osteoporosis. Baseline characteristics (mean±SD) included: age = 72.9±3.0 years-old, BMI =26.0±3 kg/m2. 26.9% patients were noted to have history of smoking, while 7.6% had rheumatoid arthritis, 65% had history of diabetes mellitus, 54% were noted to be on prednisone as part of post-transplant immunosuppression regimen with dosages varying between 5-10mg daily. 61.5% of patients had GERD, whereas 57.1% were treated with proton pump inhibitors and H2-blockers. Analysis of DXA parameters revealed the lowest T-score average to be -1.88±0.5 with 88% having low BMD at the femoral neck site. Average TBS in the group was noted to be 1.37±0.1, while vertebral compression fractures were noted in 21% of these patients. Only 76% of patients were on osteoporosis treatment, where 65% were treated with Alendronate, 25% were treated with Denosumab and 20% with Zolendronic acid. Sub group analysis based on the solid organ transplanted reported liver transplant in 46%, renal transplant in 30%, lung transplant in 15%, heart transplant in 7% of the patients. Patients in the liver transplant group had a lower TBS of 1.26 (vs. 1.46 in the renal, 1.45 in the heart and 1.33 in the lung transplant groups). Incidence of vertebral compression fractures was highest in this subgroup and noted in 27% patients. Notably 25% of liver transplant were diagnosed with osteoporosis solely based on presence of vertebral compression fractures. Conclusion: Our quality improvement study highlights the fact that lowest DEXA scan T-scores are most commonly found at the femoral neck site in solid organ transplant recipients and high incidence of fragility fractures. Thorough assessment for vertebral fractures should be routinely incorporated while evaluating DXA scans in post-transplant osteoporosis cases, especially recipients of liver transplants as vertebral compression fractures can be the sole determinant of osteoporosis in this group of patients.
Presentation: Friday, June 16, 2023