Researchers discovered that the screening program for cystic fibrosis-related bone disease (CFBD) varied widely across the United States, causing some patients to miss out on the screening program altogether, according to results of a new study published in the Journal of Cystic Fibrosis.

To improve the quality of life in patients with cystic fibrosis, CFBD monitoring has been proposed to monitor bone health. CFBD can be defined as low bone mineral density on dual-energy X-ray absorptiometry (DXA). Patients with cystic fibrosis are at a higher risk of osteoporosis and osteopenia than the general population. However, the true incidence of CFBD is unknown. 

“Factors hypothesized to contribute to CFBD include malnutrition, pancreatic insufficiency, diabetes, vitamin D and calcium deficiency, reduced anabolic hormones (Insulin-like growth factor-1), hypogonadism, glucocorticoid use, and chronic inflammation,” Ratti and colleagues wrote.

Read more about cystic fibrosis etiology

The researchers of this study turned to the Cystic Fibrosis Foundation Patient Registry to collect data on screening performed in cystic fibrosis patients according to the recommended intervals. The research team sought to evaluate how often DXA screenings were utilized, classifying patients into 3 groups: low screening, medium screening, and high screening. 

There were 15,134 individuals recruited for the study; among them, 611 (40%) did not undergo DXA, while 9023 (60%) did. The median rate for participants who attended at least 1 DXA screening during the study period was 66%.

“Seventy-nine adult programs (70%) screened over 50% of their population, while 34 screened less than 50% of their population at least once during the study period,” Ratti et al said.

“Programs which were in the high screening quartile performed at least one DXA on >76% of their population and programs in the low screening quartile performed DXA screening on <44% of their population.”

It is therefore recommended that physicians have the tools to identify patients with cystic fibrosis who would benefit most from early treatment intervention and that the true prevalence of CFBD in the US is determined. 


Ratti GA, Fernandez GS, Schechter MS, et al. Bone mineral density screening by DXA for people with cystic fibrosis: a registry analysis of patient and program factors influencing rates of screening. J Cyst Fibros. Published online January 24, 2022. doi:10.1016/j.jcf.2022.01.011