People with cystic fibrosis (CF) are vulnerable to osteopenia and osteoporosis. Osteopenia is a common bone disease in which bones have fewer minerals and are weak; it often leads to osteoporosis, which describes a condition where the bones are less thick or dense and are weaker, leading to a higher risk of fractures. Osteopenia generally happens before osteoporosis. It can happen at any age, but in people with CF, it is more common in the late teens and in adults. Preventing osteoporosis is very important for people with CF.

As people with CF have difficulties in absorbing vitamin D, they have a higher risk of developing osteoporosis. Vitamin D helps the body absorb calcium, which is an essential mineral for bone density. Other osteoporosis risk factors include poor childhood nutrition, chronic infections, delayed puberty, diabetes, a sedentary lifestyle, and treatment with corticosteroids, which people with CF use due to lung transplants or severe inflammation.

Diabetes, alcohol use and smoking can also accelerate the onset of osteoporosis. People with CF should have their vitamin D levels checked and be screened for diabetes every year.

Screening for osteoporosis and osteopenia is done by checking height and weight. Development during puberty is also tracked.

A doctor may want to scan a CF patient with a dual-energy X-ray absorptiometry (DEXA). It’s painless and checks bone mass or density and is a good tracker for osteoporosis, as it uses two separate X-rays to check bone thickness throughout the body as a way to predict the chance of future breaks. Results are then reported as T-scores and Z-scores. A T-score of -1.0 to -2.5 is an osteopenia indicator and a score of less than -2.5 indicates osteoporosis.

Nutrition, lung disease and bone health are all related. If people with CF do not feel well, they will eat less and become less active, weakening muscles and bones. A low body weight can lead to low bone density and fractures. Lung inflammation can also lead to bone loss.

Prevention is the best defense against developing osteoporosis. This includes a healthy lifestyle, with adequate food intake and supplementation. Daily activities and exercise are also important, as it is known that an increase in weight-bearing activity can help people gain 5 percent in bone mass. Exercise can reduce a 40 percent lifetime risk in developing osteoporosis, as well as the added benefit of maintaining better lung function.

Depending on the severity of the disease, bisphosphonates may be prescribed to help encourage new bone growth.

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