Lung Transplant Case Shows Bone Loss To Be Reversible
When Mitch Davey was being considered for a lung transplant at Shands Transplant Center at the University of Florida, doctors discovered he had severe osteoporosis.
The drugs he had taken for years to improve symptoms of his lung disease caused him to lose 30 percent of the bone mass in his spine and pelvis. Doctors feared that transplantation and larger doses of the same drugs would cause further bone loss and jeopardize his recovery from surgery.
Three years later, Davey, now 44, leads a normal life with strong bones and new lungs, thanks to a UF research program.
In a three-year study scheduled to be published this fall in the Journal of Heart and Lung Transplantation and the Journal of Cardiopulmonary Rehabilitation, UF researchers discovered the bone loss and osteoporosis caused by prednisone, a medicine for patients with lung failure and lung-transplant recipients, is not only preventable but reversible through weight-lifting exercises.
The findings contradict the once commonly held belief that organ transplant recipients receiving prednisone should not participate in weight-lifting exercises because they may be at greater risk for muscle and bone injury.
Physicians who do encourage exercise in their transplant recipients often recommend only cardiovascular exercises such as walking, which has little beneficial effect on preventing osteoporosis, said Dr. Randy Braith, an associate professor of exercise physiology in UF's exercise and sport sciences department and joint associate professor in UF's College of Medicine.
Braith said the resistance-exercise study is significant because few medications can stop bone loss and even fewer effectively stimulate new bone growth.
In the study, two groups of eight lung recipients underwent different treatments beginning two months after transplantation. One group participated in the supervised weight-lifting exercises in the Center for Exercise Science within the College of Health and Human Performance, while the other group participated in walking exercise only.
The researchers used a weight-lifting machine manufactured by MedX Corp. that targets the lumbar region of the back, the area most susceptible to fractures. The patients worked for only a few minutes once a week to build up the bone destroyed by prednisone, Braith said. Both groups received the traditional immuno-suppressant drugs, including prednisone.
At the end of the six-month study, the resistance-exercise group added an average 15 percent bone mass in the lumbar spine, but the group that did not participate in weight-lifting exercise added no bone mass.
Braith said nearly 70 percent of lung-transplant candidates already have established osteoporosis before transplantation. In those who receive new lungs, the immune system suppression drugs necessary to prevent rejection destroy an additional 10 percent to 20 percent of the remaining bone mass in the lumbar spine. Braith said the resistance-exercise equipment has proven effective in restoring lost bone.
"In just six months, we were bringing the patients back to pre-transplant levels of bone mass," Braith said. "After the six months, the patients didn't want the study to be over."
He also said 50 percent of organ recipients nationally have long-bone fractures and 25 percent have spinal fractures. Among patients using the weight-training program, he said, there were no incidents of fractures or injuries.
Davey, of Starke, Florida, said he definitely noticed the difference.
"I felt stronger and I knew I was stronger," he said. "It helped me as far as preparing me to have a positive attitude. I can't even imagine life without the resistance training. It helps you physically, mentally and emotionally."
Matt Mitchell, a UF doctoral student who coordinated the project, stresses that the research findings are applicable to other organ recipients as well as the general public.
"This study is definitely applicable to other transplant groups; we really think lung-transplant patients are in the worst condition," he said. "If we can improve the strength and bone mass of a group so deconditioned, it can definitely be applied toward other transplant groups and to an older population with osteoporosis."
In fact, the current study with lung transplant recipients is an extension of an original research study with heart transplant recipients that began in 1992, Braith said.
"Our first weight-lifting study with heart transplant recipients was driven by desperation; we simply couldn't prevent post-transplant osteoporosis with calcium supplements and drugs, but six months of the specific weight-lifting exercises restored bone to pre-transplant levels in those heart patients," he said. - By Kate Palmer
UniSci (Daily University Science News)
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