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Joint Bone Spine
Volume 83, n° 2
pages 207-211 (mars 2016)
Doi : 10.1016/j.jbspin.2015.04.021
accepted : 19 April 2015
Body composition, lung function, and prevalent and progressive bone deficits among adults with cystic fibrosis

Joshua F. Baker a, b, c, , Melissa S. Putman d, e, Karen Herlyn f, Angela Pizzo Tillotson g, Joel S. Finkelstein d, Peter A. Merkel b, c
a Division of Rheumatology, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia 19104, United States 
b Division of Rheumatology, University of Pennsylvania, 3600 Spruce Street, Philadelphia PA 19104, United States 
c Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 19104, United States 
d Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston 02114, United States 
e Division of Endocrinology, Boston Children's Hospital, Boston 02114, United States 
f Poliklinik fuer Rheumatologie, University Hospital Schleswig-Holstein, Campus Luebeck, 23562 Lübeck, Germany 
g Mattina R. Proctor Diabetes Center, Mercy Hospital, Portland 04106, United States 

Corresponding author. Division of Rheumatology, Philadelphia VA Medical Center, 8 Penn Tower Building, 34th and Civic Center Boulevard, Philadelphia 19104, United States.

Cystic fibrosis (CF) is associated with osteoporosis and incident fracture. This study assessed independent predictors of baseline and 2-year changes in bone mineral density (BMD) in adults with CF.


Sixty-four adult patients with CF, ages 18–57, were recruited from the Massachusetts General Hospital Cystic Fibrosis Care Center. Dual-energy X-ray absorptiometry (DXA) was performed at the spine and radius at baseline and 2 years (in 39 subjects). Estimates of fat-free mass index (FFMI) and fat mass index (FMI) were determined using height, weight, and tetrapolar bioelectric impedance analysis. All subjects completed lung spirometry within 1 month of the study visit. Linear regression models evaluated predictors of baseline BMD Z-scores and change in PA spine BMD Z-score over 2 years. Two definitions of low BMD were studied based on Z-score (≤–1.0 and ≤–2.0).


Low BMD was present in 52% of subjects. Subjects with low BMD were more likely to be male (67% vs. 32%, P =0.009), were more likely to be currently using glucocorticoids (21% vs. 0%, P <0.001), had lower percent body fat (P =0.04), and were more likely to have had a previous fracture (60% vs. 46%, P =0.007). In multivariable models, greater FFMI and height, but not greater FMI, were associated with greater BMD. In multivariable models, low forced vital capacity (FVC) and greater FMI were associated with greater loss of BMD at the PA spine over two years.


Male sex, short stature, and low lean mass are associated with low BMD in CF. Greater adiposity and lower lung function are predictors of negative change in BMD Z-score over 2 years.

The full text of this article is available in PDF format.

Keywords : Cystic fibrosis, Bone mineral density, Pulmonary function test, Dual-energy X-ray absorptiometry, Fat-free mass, Fat mass

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