Abstract
Cystic fibrosis (CF) is a serious autosomal recessive genetic disorder associated with chronic lung disease, malabsorption, malnutrition, pancreatic insufficiency and premature respiratory failure. Recent advances in medical science and technology have increased the lifespan of patients with CF, albeit with long-term consequences of the disease, such as osteoporosis, becoming of increasing significance. The medical treatment of osteoporosis in patients with CF or after organ transplantation is still being explored, and no clear guidelines regarding the best choice of bisphosphonate exist. We report a case of a young woman with CF, lung transplantation and low bone mass developing long-term leukopenia after treatment with zoledronic acid. The leukopenia, with a strong affection of the neutrocytes, lasted for 4 months and the condition only went into remission after granulocyte-colony stimulating factor (G-CSF) treatment. It is important to be aware of symptomatic leukopenia in immunosuppressive patients after treatment with zoledronic acid.
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References
Cystic Fibrosis Foundation (2013) Cystic Fibrosis Foundation Patient Registry 2012 Annual Data Report
Conwell LS, Chang AB (2014) Bisphosphonates for osteoporosis in people with cystic fibrosis. Cochrane Database Syst Rev 3:CD002010
Gore AP, Kwon SH, Stenbit AE (2010) A roadmap to the brittle bones of cystic fibrosis. J Osteoporos 2011:926045
Stalvey MS, Clines GA (2013) Cystic fibrosis-related bone disease: insights into a growing problem. Curr Opin Endocrinol Diabetes Obes 20:547–552
Aris RM, Renner JB, Winders AD, Buell HE, Riggs DB, Lester GE, Ontjes DA (1998) Increased rate of fractures and severe kyphosis: sequelae of living into adulthood with cystic fibrosis. Ann Intern Med 128:186–193
Chapman I, Greville H, Ebeling PR, King SJ, Kotsimbos T, Nugent P, Player R, Topliss DJ, Warner J, Wilson JW (2009) Intravenous zoledronate improves bone density in adults with cystic fibrosis (CF). Clin Endocrinol (Oxf) 70:838–846
Black DM, Reid IR, Boonen S, Bucci-Rechtweg C, Cauley JA, Cosman F, Cummings SR, Hue TF, Lippuner K, Lakatos P, Leung PC, Man Z, Martinez RL, Tan M, Ruzycky ME, Su G, Eastell R (2012) The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 27:243–254
Black DM, Reid IR, Cauley JA, Cosman F, Leung PC, Lakatos P, Lippuner K, Cummings SR, Hue TF, Mukhopadhyay A, Tan M, Aftring RP, Eastell R (2015) The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 30:934–944
Reid DM, Devogelaer JP, Saag K, Roux C, Lau CS, Reginster JY, Papanastasiou P, Ferreira A, Hartl F, Fashola T, Mesenbrink P, Sambrook PN (2009) Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 373:1253–1263
Aris RM, Lester GE, Renner JB, Winders A, Denene BA, Lark RK, Ontjes DA (2000) Efficacy of pamidronate for osteoporosis in patients with cystic fibrosis following lung transplantation. Am J Respir Crit Care Med 162:941–946
Derry CJ, Derry S, Moore RA (2012) Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database Syst Rev 2:CD008615
Bodingbauer M, Wekerle T, Pakrah B, Roschger P, Peck-Radosavljevic M, Silberhumer G, Grampp S, Rockenschaub S, Berlakovich G, Steininger R, Klaushofer K, Oberbauer R, Muhlbacher F (2007) Prophylactic bisphosphonate treatment prevents bone fractures after liver transplantation. Am J Transplant 7:1763–1769
Crawford BA, Kam C, Pavlovic J, Byth K, Handelsman DJ, Angus PW, McCaughan GW (2006) Zoledronic acid prevents bone loss after liver transplantation: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 144:239–248
Haas M, Leko-Mohr Z, Roschger P, Kletzmayr J, Schwarz C, Mitterbauer C, Steininger R, Grampp S, Klaushofer K, Delling G, Oberbauer R (2003) Zoledronic acid to prevent bone loss in the first 6 months after renal transplantation. Kidney Int 63:1130–1136
Schwarz C, Mitterbauer C, Heinze G, Woloszczuk W, Haas M, Oberbauer R (2004) Nonsustained effect of short-term bisphosphonate therapy on bone turnover three years after renal transplantation. Kidney Int 65:304–309
Shane E, Cohen A, Stein EM, McMahon DJ, Zhang C, Young P, Pandit K, Staron RB, Verna EC, Brown R, Restaino S, Mancini D (2012) Zoledronic acid versus alendronate for the prevention of bone loss after heart or liver transplantation. J Clin Endocrinol Metab 97:4481–4490
Jayakar BA, Abelson AG, Yao Q (2011) Treatment of hypertrophic osteoarthropathy with zoledronic acid: case report and review of the literature. Semin Arthritis Rheum 41:291–296
Reginster JY, Gritten C, Diverse P, Hauwaert PC, Crielaard JM, Halleux R, Franchimont P (1985) Treatment of Paget’s disease with low dose sodium etidronate (5mg/kg/day). Occurrence of reversible transient suspected leukopenia. Rev Rhum Mal Osteoartic 52:145–150
O’Doherty DP, Bickerstaff DR, McCloskey EV, Hamdy NA, Beneton MN, Harris S, Mian M, Kanis JA (1990) Treatment of Paget’s disease of bone with aminohydroxybutylidene bisphosphonate. J Bone Miner Res 5:483–491
Arden-Cordone M, Siris ES, Lyles KW, Knieriem A, Newton RA, Schaffer V, Zelenakas K (1997) Antiresorptive effect of a single infusion of microgram quantities of zoledronate in Paget’s disease of bone. Calcif Tissue Int 60:415–418
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AK none, ALT has received a grant from Eli Lilly, NHB none, PE is an advisory board member with Amgen, MSD and Eli Lilly, at the speaker’s bureau with Amgen, Eli Lilly and Boehringer Ingelheim, stocks owners of Novo Nordisk A/S
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Karahasanovic, A., Thorsteinsson, AL., Bjarnason, N.H. et al. Long-term leukopenia in a lung transplanted patient with cystic fibrosis treated with zoledronic acid: a case report. Osteoporos Int 27, 2621–2625 (2016). https://doi.org/10.1007/s00198-016-3559-x
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DOI: https://doi.org/10.1007/s00198-016-3559-x