Decrease in bone mineral density in children with cystic fibrosis: dynamics over 15 years

Relevance. The actuality of the problem of osteoporosis in children with cystic fibrosis (CF) is due to the high risk of a decrease in bone mineral density (BMD) in this category of patients. According to the Register of Patients with cystic fibrosis in the Russian Federation for 2021, this complication occurs in 6.4% of patients (1.8% of children and 19.2% of adults). Factors such as chronic inflammation, malabsorption and maldigestion syndromes, hormonal, anti-inflammatory drugs, metabolic disorders negatively affect the processes of regulation of bone metabolism, which leads to a decrease in BMD, osteoporosis and fractures in this nosology. Studying the dynamics of the frequency of decrease in BMD in children with CF with new diagnostic and therapeutic approaches will allow us to evaluate the effectiveness of measures used to detect osteoporosis and propose new algorithms for prevention and treatment. Objective: to assess the dynamics over the follow-up period 2006-2021 of the frequency of decrease in BMD in children with CF. Materials and methods: In 2006, 128 patients with cystic fibrosis - 60 boys and 68 girls aged 5-18 years - were examined on the basis of the FSAEI HE N. I. Pirogov RNRMU MOH. In 2020-2021, 40 children with cystic fibrosis (28 girls, 12 boys aged 13.6±2.4 years) and 35 healthy children (24 girls, 11 boys aged 14.2±2.2 years) were examined on the basis of the RCIC. The condition of the patients’ bone tissue was assessed by conducting dual-energy X-ray absorptiometry (DHA) in the lumbar spine (L2-L4) and bone mineral content (BMC). Dietary calcium intake and respiratory function were evaluated in all patients with CF. Results. In 2006, a decrease in BMD <-2 Z-score was found in 35 (27%), osteopenia (Z-score BMD <-1) - in 33 (26%) patients with CF. In 2021, a decrease in BMD <-2 Z-score was detected in one child (2.5%) with CF, osteopenia - in 10 (25%) children. In all healthy children, BMD indicators were within the normal range. The average BMD in patients with CF in 2021 was lower - 0.26±1.3 g/cm2 compared to healthy 0.74± 0.7g/cm2 (p=0.000). BMC values in patients with CF were also lower - 39.6±13.0g versus 50.4±14.8g (p=0.000) in healthy patients. Dietary calcium intake in 2021 was 1830.5 ±782.2 mg/day, which is 3 times higher than in patients in 2006-543± 44 mg/day (p=0.000). Lung function in patients in 2021 was higher, FEV1 83.1%±17.8, compared with 67.9%±23.1 in patients in 2006 (p<0.05). Conclusion: new methods of diagnosis and therapy have significantly reduced the frequency of decrease in BMD in children with cystic fibrosis. However, these indicators still do not reach the values of healthy children.

children, cystic fibrosis, osteoporosis, osteopenia, densitometry, mineral density, calcium intake

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