309 Lactose Intolerance is a Risk Factor for Decreased Bone Mineral Density in Pancreatic Insufficient Cystic Fibrosis Children

Objectives: Audit of current practice at the Bristol Adult CF Centre against the 2007 UK CF Trust recommendations in regard to dual-energy X-ray absorptiometry (DEXA) scans, calcium intake, vitamin D status and bisphosphonate treatment.Methods: A retrospective case note audit for patients that had an annual review in 2010.Data was compared with the 2007 UK CF Trust recommendations for bone health.Results: 106 patients were invited for annual review in 2010: 93 (88%) attended.Of these 93 patients 84 (90%) had a DEXA scan within the last 3 years, 7 (8%) did not attend, 1 (1%) refused and 1 (1%) scan was not ordered.Despite measures to optimise bone health, 17 (20%) patients still met clinical criteria for bisphosphonate treatment of whom 13 (15%) were receiving treatment.In 4 patients (5%) treatment was delayed for clinical reasons.7 patients (8%) were taking bisphosphonates that no longer met the criteria.Serum 25-OH vitamin D was measured in 86 patients (92%): 59 (69%) had a level below the recommended 75 nmol/l.All patients had been prescribed vitamin supplements appropriately.Poor adherence to vitamin therapy was identified in 11 patients (12%).Calcium intake was assessed in 81 patients (87%): 38 (47%) had a calcium intake below the recommended 1300 mg/day even with ongoing dietetic support. Conclusion:This audit has highlighted the challenges of meeting the UK CF Trust recommendations relating to vitamin D status and calcium intake despite dietetic advice and monitoring.It has also raised awareness that there are a small number of patients receiving bisphosphonate treatment that may no longer be clinically indicated.