High prevalence of early-onset osteopenia/osteoporosis after allogeneic stem cell transplantation and improvement after bisphosphonate therapy

Abstract

Osteopenia/osteoporosis (O/O) has been associated with allogeneic stem cell transplantation (alloSCT). We retrospectively reviewed 102 patients undergoing a first alloSCT from 2000 to 2005 at our center to evaluate the prevalence of O/O p6 and 46 months post-alloSCT. Fifty-six patients did not have a dual energy X-ray absorptiometry (DXA) scan following alloSCT. Approximately half (n ¼ 13/27) of those with a first DXA scan p6 months post-alloSCT had O/O and a similar rate (n ¼ 9/19) was seen in those with a first DXA scan 46 months. There were no significant differences in patient characteristics between the normal and O/O groups. The dual femur (DF) appeared to be more vulnerable to alloSCTinduced bone mineral density (BMD) loss than the lumbar spine (LS), regardless of screening time. O/O patients were treated with bisphosphonates and 41% had a repeat DXA scan post-treatment. No patient developed jaw osteonecrosis and significant BMD improvement was seen at the LS (mean BMD, 1.03 ± 0.13 vs 1.08 ± 0.12, P ¼ 0.004) but not the DF (mean BMD, 0.84±0.06 vs 0.85 ± 0.08, P ¼ 0.29), indicating BMD loss at the DF is more resistant than the LS to antiresorptive therapy. Our results demonstrate that O/O is an early and late complication post-alloSCT and bisphosphonate treatment reverses BMD loss at the LS.

Factors influencing the late phase of recovery after bone mineral density loss in allogeneic stem cell transplantation survivors

“…Anti-resorptive bisphosphonate therapy is rapidly gaining acceptance in this difficult cohort of subjects, but its effects are variable; they have been shown to improve BMDL at the lumbar spine but not at the femoral neck. 28 Pamidronic acid reduces BMDL at the femoral neck and hip especially in patients receiving high doses of glucocorticoids for GvHD treatment. 26,29 Treatment with risedronate for 12 months increased BMD significantly at the lumbar spine and prevented further bone loss at the femoral neck in the long-term survivors after SCT.…”

Bone Mineral Turnover after Allogeneic Hematopoietic Stem Cell Transplantation in Children: A Single Center Cohort Study

“…Нельзя исключить занижение показателей в связи с недостаточной диагностикой нарушений. Так, кумулятивный риск развития снижения костной плотно-сти в нашей выборке составил 17,2%, что ниже данных, приводимых в литературе [4][5][6].…”

“…Потеря плотности костной ткани, ассоциированная с ТГСК, является муль-тифакторным, быстро прогрессирующим и длительным нарушением [3]. Снижение костной плотности диагно-стируется у 24-50% пациентов в период от 2 до 12 мес после аллогенной ТГСК [4][5][6], а кумулятивная частота аваскулярных некрозов составляет от 6 до 19% за 3 года после ТГСК [2].…”

The role of Insulin-like Growth Factor 1, Receptor Activator for Nuclear Factor κB ligand — Osteoprotegerin system, Interleukin 6 and 1β in post-transplantation bone metabolic disease in childhood

“…Based on dual-energy X-ray absorptiometry, more than half of long-term survivors show bone loss after HSCT [3][4][5]. Some factors influencing bone remodelling after transplantation like hypogonadism, glucocorticoid exposure, use of calcineurin inhibitors, secondary hyperparathyroidism, hyperthyroidism, and calcium and/or vitamin D deficiency, are already known [6][7][8].…”