Etiology of those who fractured after transplant included 8 patients with chronic obstructive pulmonary disease (COPD), 5 with idiopathic pulmonary fibrosis (IPF), 2 with sarcoidosis, 1 with scleroderma, and 1 with alpha 1 antitrypsin deficiency (A1AD). This evidence concerns the gene SERPINA1 and idiopathic pulmonary fibrosis.