Osteoporosis: An ignored complication of CVID.
Pediatr Allergy Immunol. 2011 Nov;22(7):676-83. doi: 10.1111/j.1399-3038.2011.01187.x. Epub 2011 Jun 6.
Baris S, Ozen A, Ercan H, Karakoc-Aydiner E, Cagan H, Ozdemir C, Barlan M, Bahceciler NN, Barlan IB.
Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey Division of Pediatric Allergy and Immunology, Yeditepe University, Istanbul, Turkey Division of Radiology, Florence Nightingale Hospital, Istanbul, Turkey.
Background:? Multiple factors in common variable immunodeficiency (CVID) might interfere with optimal growth and maturation and potentially compromise bone health.
Methods:? We aimed to evaluate bone mineral density (BMD) of patients with CVID using dual energy X-ray absorptiometry (DEXA) and investigate risk factors associated with decreased bone density.
Results:? Twenty-two patients were included (M: 16, F: 6) with a mean age of 15.6?±?9.0?yr. DEXA revealed osteopenia in 6/22 (27.3%) and osteoporosis in 9/22 (40.9%) at lumbar spine and osteopenia in 7/19 (37%) and osteoporosis in 3/19 (16%) at femoral neck sites. The age of subjects with osteoporosis was significantly higher than those without (21.6?±?8.0 vs. 9.0?±?5.7?yr; p?<?0.0001). BMD z-scores were significantly lower in patients with bronchiectasis compared with those without (p?=?0.03). Patients with osteoporosis at femoral neck site had lower forced expiratory volume in 1?s (FEV(1) ) (p?=?0.024), FEV(1) /forced vital capacity (FVC) (p?<?0.0001), PEF (p?=?0.008), and FEF 25-75 (p?=?0.013) values compared with the patients with normal BMD z-scores. Low serum 25(OH) vitamin D levels were detected in 13/22 patients and low dietary calcium intake in 17/22 patients. BMD z-scores at femoral neck were lower in patients with low B-cell percentage (p?=?0.03). BMD z-score at lumbar spine was correlated with folate (r?=?+0.63, p?=?0.004) and serum immunoglobulin G levels (r?=?+0.430, p?=?0.04).
Conclusion:? Osteoporosis appeared as an emerging health problem of patients with CVID, the risk increasing with older age and poorer lung function. Nutritional, biochemical, and immunologic factors appeared to take part in decreased BMD. Insight into the mechanisms of osteoporosis in CVID is crucial to develop preventive strategies.
© 2011 John Wiley & Sons A/S.
– – – – – – –
Clips from Common Variable Immune Deficiency Overview
Disease characteristics. Common variable immune deficiency (CVID) is characterized by humoral immune deficiency with onset after 24 months of age and usually in young adulthood, resulting in increased susceptibility to infections and diminished responses to protein and polysaccharide vaccines.
The most common infections are sinopulmonary and include S
- treptococcus pneumonia,
- Hemophilis influenza,
- Klebsiella pneumonia, and sometimes
- mycoplasma infections.
Individuals may experience meningitis or other systemic bacterial infections, recurrent eye or skin infections, or gastrointestinal symptoms related to compromised immune/gut homeostasis, including chronic diarrhea, malabsorption, or bloating. They may also have abnormal T-cell function and immune dysregulation, including lymphoid hyperplasia, gastrointestinal inflammation, autoimmune phenomena, and susceptibility to malignancy, especially lymphomas.