LAUSR

Background Osteoporosis(OP) is a known complication before and after a lung transplant. In addition to altering bone mass, treatment with glucocorticoids alters the bone microarchitecture, conditioning an increased risk of fracture in these patients. Denosumab(Dmab) is a monoclonal antibody approved for the treatment of postmenopausal OP and its use for corticoid OP is pending approval. Objectives To describe the subcohort of lung transplant patients who have been treated with Dmab. To study the evolution of bone mass in patients with lung transplantation, with OP induced by glucocorticoids, treated with Dmab. Methods We included 19 lung transplant patients between 1995 and 2017 controlled in rheumatology for OP and in treatment with Dmab. Of these 19 patients, the evolution of bone mass of the 9 patients who have completed a minimum of 12 months of treatment is shown. Bone densitometry(DXA) was performed on a General Electric Healthcare Lunar Prodigy Advance 15 version densitometer, before and after treatment with Dmab. Demographic data of the patients were collected, the diagnosis of the disease that motivated the transplant, the glucocorticoid doses before and after the transplant, as well as the immunosuppressive treatment. In the 9 patients with DXA follow-up, the 3D-SHAPER software was applied in the DXA before and after the transplant. Results We included 19 patients(10 women) with a mean age of 58.6 years±11.4. The diagnosis of the disease that led to the transplant was in 4 COPD patients, 6 patients with pulmonary fibrosis or diffuse interstitial disease, 2 with bronchiectasis, 2 patients with cystic fibrosis, 1 with histiocytosis X, 2 with lymphangioleiomyomatosis, 1 with bronchiolitis obliterans and 1 patient with pulmonary hypertension. Before transplantation, 8 patients (42.1%) had required high doses of glucocorticoids. The prevalence of OP prior to start Dmab treatment in the 19 lung transplant patients was 94.7%. The means of BMD in g/cm2 and T-score before treatment with Dmab and the results of the 3D-SHAPER are shown in table 1. DMO g/cm2 T-score Lumbar spine 0,909±0,13 −2,40±1,08 Femoral Neck 0,708±0,94 −2,50±0,77 Total Hip 0,702±0,86 −2,73±0,59 Cortical Density (g/cm2) 109,3±7,7 −2,9±0.3‡ Trabecular vBMD (g/cm3) 85,7±21,4 −2,9±0.8‡ Integral vBMD (g/cm3) 198,7±19 −3,3±0,5‡ The mean time in which the DXA was performed prior to the treatment with Dmab with respect to the transplant date was 4.31±5.83 years. The mean time in which the DXA was performed after the start of Dmab was 19±4.17 months. The results of the evolutionary BMD, the 3D-SHAPER study and its percentage of change are shown in table 2. Of these 9 patients, 88.9% had received osteoactive treatment before Dmab, 5 with oral bisphosphonates and 3 with endovenous bisphosphonates. The mean time of treatment with bisphosphonates until the onset of Dmab was 5.4 years. There were no significant differences in BMD evolution between patients treated for OP prior to Dmab and those not treated, nor for 3D-SHAPER. Conclusions All patients who started treatment with Dmab had a diagnosis of OP except one patient with osteopenia. The mean increase in BMD in patients treated with Dmab was significant in all the regions assessed, being higher in the lumbar spine. There was an increase in cortical density, trabecular volumetric BMD and integral volumetric BMD after Dmab treatment, although this increase was not significant for any of the three parameters. Disclosure of Interest None declared