Supplementary Material for: Bone health in young lung transplant recipients – a retrospective study

Introduction There is limited data on the prevalence and treatment of low bone density in young lung transplant recipients (LTRs), even though osteoporosis is common in patients with end-stage lung disease and transplant recipients. This study aimed to assess bone health in young LTRs. Methods We retrospectively reviewed medical records for LTRs aged 18–50 at transplant. Outcomes included post-transplant low bone density (z-score < -2), osteoporotic fractures, and treatment data. Results Among 150 LTRs (45% female, mean age 38 ± 9 years), with a median follow-up of 6.2 years, 103 (69%) underwent bone density scans; 82 occurred within the first-year post-transplant. Of these, 19 (23%) showed low bone density within the first year. Post-transplant osteoporotic fractures occurred in 34 patients (23%), including femoral neck (32%) and vertebral fractures (29%) as first events. Eleven patients (32%) experienced multiple fractures. Pre-transplant fracture history significantly predicted post-transplant fractures (HR 6.720, 95% CI 1.572–28.724). Osteoporosis treatment was given to 41 patients (27%), primarily with bisphosphonates (93% as first-line). Of those treated, 49% remained fracture-free during follow-up. Conclusion Young LTRs face high rates of low bone density and fractures, including serious and recurrent fractures. These findings underscore the need for early screening and intervention to reduce osteoporosis-related morbidity in this vulnerable population.