Musculoskeletal System

Several factors contribute to development of bone disease in CF: (a) malabsorption of vitamins D and K and calcium; (b) poor nutrition and decreased body mass; (c) physical inactivity; (d) corticosteroid therapy; and (e) delayed puberty. Chronic pulmonary infection, through release of inflammatory cytokines, can cause increased bone resorption and decreased formation. Osteopenia, osteoporosis, pathological fractures, and kyphosis can then occur.10 Episodic or chronic arthritis and hypertrophic pulmonary osteoarthropathy may also occur due to immune complex formation in response to chronic inflammation.11 Digital clubbing is commonly observed and is a marker for hypoxia.

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