Impact of Impaired Glucose Metabolism on Bone Mineral Density in Patients with Cystic Fibrosis

Cystic fibrosis (CF) is a chronic genetic disorder characterized by pancreatic insufficiency and lung disease. Advancements in highly effective modulator therapies (HEMTs) have improved life expectancy, shifting the focus to endocrine comorbidities, such as CF-related diabetes (CFRD) and bone disease (CFRBD). Increased risk of osteoporosis has been shown in type 1 and type 2 diabetes; however, there are limited studies evaluating the impact of glucose metabolism disorders on osteoporosis in children with cystic fibrosis. Therefore, this study investigates the impact of glucose metabolism disorders on people with cystic fibrosis (PwCF). Methods : This cross-sectional retrospective study included 81 PwCF screened for glucose and bone metabolism between 2019 and 2024. Data on demographics, CFTR variants, glucose metabolism, and bone metabolism were analyzed. Cases were categorized as normal, indeterminate, impaired glucose tolerance (IGT), or CFRD based on OGTT. Statistical analyses were conducted to determine factors affecting bone health, including pairwise comparison and multivariate regression analysis. Results : Of the 81 cases, 55 (67.9%) had normal glucose tolerance, 9 (11.1%) had indeterminate (INDET), 9 (11.1%) had impaired glucose tolerance (IGT), and 8 (9.9%) had CFRD. IGT and CFRD cases demonstrated significantly lower body mass index (BMI), lung function, and dual energy X-ray absorptiometry (DEXA) z-scores than the normal group. HbA1c had the most detrimental impact on bone density, while elevated BMI levels were protective. HEMT showed no significant impact on glucose or bone metabolism, likely due to short treatment durations. Conclusions : Impaired glucose metabolism has a significant impact on bone health in PwCF. Integrated monitoring of glucose and bone metabolism, along with a multidisciplinary approach is essential to optimize outcomes and reduce complications.