Vertebral fractures lead me down a new path on my health journey

Leave no stone unturned. This is a basic tenet of any investigation, something I learned very early in my career as a special agent. It also seems to be a practice employed by my healthcare team, which now includes an additional doctor.

Last week, I added endocrinologist Oksana Davydov to my team. Davydov specializes in the management of osteoporosis and metabolic bone disease. When I was diagnosed with idiopathic pulmonary fibrosis (IPF) in January 2017, I had a primary care physician, a dentist, and a gastroenterologist. Today, several years post-transplant, I have more than a dozen physicians in as many specialties.

After identifying a second non-traumatic compression fracture in my spine, this one in my T7 vertebra, my team at the transplant clinic referred me to endocrinology to ensure no stone was left unturned. I was already seeing a nurse practitioner in orthopedics after the first fracture was identified in T10.

The purpose of my endocrinology appointments is to determine if anything other than my post-transplant medications may be contributing to the vertebral fractures. I began taking prednisone shortly after my IPF diagnosis and continued following my bilateral lung transplant in July 2021. Davydov also noted that CellCept (mycophenolate mofetil), Prograf (tacrolimus), and Rapamune (sirolimus) could be contributing to changes in my bone density. These medications help to prevent rejection of my transplanted lungs.

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No stone left unturned

I left that appointment with a list of tests to complete to help Davydov finalize a treatment plan. High on the list was a dual-energy X-ray absorptiometry, or DEXA, scan, which measures bone density. Because I was previously diagnosed with osteopenia, I’ve had four DEXA scans since 2017. Typically, insurance will cover a scan every two years, but for solid organ transplant patients like me, annual scans are covered.

Most scans sample bone density in the long bones of the arms, the hips, the neck, and the lumbar spine. This time, my doctor has requested three types of DEXA scans:

• A scan of my appendicular skeleton to look at my arms, legs, pelvis, and shoulders
• A scan of my axial skeleton to look at my head, neck, back, and chest bones
• A densitometric vertebral fracture assessment to look at my lumbar and thoracic spine.

The DEXA scans are noninvasive. I’ve always been comfortable during the tests, only needing to move as directed by the technician.

My endocrinologist also ordered several other tests:

• A parathyroid hormone (PTH) blood test measures the level of the hormone in the blood. PTH helps regulate levels of phosphorus, calcium, and vitamin D.
• A 24-hour urine collection examines the makeup of the urine collected, as well as how creatinine is passing through the kidneys. For this test, I will pause my regular calcium supplements for several days before the collection to see if calcium is detected in the sample.
• A serum immunofixation electrophoresis test identifies any serum protein disorders.
• X-rays of my lumbar spine (both anteroposterior, or front-to-back, and lateral, or side, views) will help my team identify any changes since my orthopedist visit in April.

I continue to walk every day, and I have no pain because of the compression fractures. Thanks to early detection, my care team is working to develop a treatment plan and address any issues as soon as possible.

I share these developments with you to be transparent about my journey. As I approach the fourth anniversary of my transplant, I view each of those years as a gift. I don’t believe I would have made it to the end of 2021 had I not received the gift of a transplant in July of that year. I am thankful that I can make every breath count.

Note: Pulmonary Fibrosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Fibrosis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to pulmonary fibrosis.