Low bone mineral density is associated with insulin resistance in bone marrow transplant subjects

Abstract

Post-BMT subjects have an increased bone fracture risk. Additionally, several factors were associated with osteopenia and osteoporosis in these individuals. We aimed to identify other factors associated with osteopenia and osteoporosis in allogeneic post-BMT subjects. We conducted a cross-sectional study with 47 allogeneic post-BMT subjects. Serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, ferritin, vitamin B 12 , insulin, glucose, cholesterol and triglyceride levels were measured. Insulin resistance and secretion were estimated through the homeostatic model assessment for insulin resistance (HOMA-IR) and homeostatic model assessment for b-cell function (HOMA-B), respectively. A bone densitometry (BMD) was also obtained. The median time after BMT was 47.7 (12-115) months. Osteoporosis was identified in 17.0% of the subjects and osteopenia in 19.7%. The mean serum ferritin (P ¼ 0.002), insulin (Po0.0001), glucose (P ¼ 0.003) and triglyceride (P ¼ 0.018) levels were higher in individuals with osteopenia/osteoporosis. HOMA-IR (Po0.0001) and HOMA-B (Po0.0001) were increased in post-BMT subjects with osteopenia/osteoporosis. There was no other factor associated with the outcome. After adjustments ferritin, serum 25(OH)D and HOMA-IR remained independently associated with osteopenia/osteoporosis; however triglycerides no longer were. In conclusion, in the present study, low serum 25(OH)D levels, high serum ferritin levels and insulin resistance were associated with osteopenia/osteoporosis in post-BMT subjects.

Decreased bone mineral density in young adults treated with SCT in childhood: the role of 25-hydroxyvitamin D

“…Even though decreased levels of 25(OH) vitamin D have been documented in adults after SCT, to our knowledge this is the first study to show this in longterm survivors after childhood SCT. 8,9 In contrast, Daniels et al 12 and Taskinen et al 14 found no relationship between BMD and calciotropic hormones in survivors after childhood SCT. As production in the skin through UVB light exposure is an important source of vitamin D, one potential pitfall when interpreting vitamin D data is the seasonal variation with lower levels during winter at our latitudes.…”

“…6,7 Furthermore, low levels of 25-hydroxy (25(OH)) vitamin D have been documented in long-term adult survivors, but only in the short term after SCT in childhood. [8][9][10] Decreased bone mineral density (BMD) has been reported after childhood SCT, but there are few long-term studies and consequently a limited number of patients who have been studied after attaining peak bone mass. 5,[11][12][13][14] The aim of the present study was to investigate the long-term effects of TBI-based SCT on BMD in a group of young adults and to explore potential risk factors for reduced BMD.…”

Bone disease after transplantation: osteoporosis and fractures risk

“…In general, the bone loss tend to stop after 12 months following transplantation and may occur a recover of lumbar spine BMD lumbar spine within 48 months, however this recover is not seen at the femur since the bone loss is greater at this site. In addition, low BMD was associated with insulin resistance (45).…”

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

“…A total of 52 patients only had one available scan and 96 patients had two to three scans recorded. Seven (3%) scans for 5 children (median age 16 years (range [13][14][15][16][17] at the scans, 3 children had one scan each and 2 children had two scans each) were recorded and the Z-scores were used in place of T-scores for these scans in the statistical analysis.…”

“…Others have also shown that BMDL in the first decade after SCT is associated with cGvHD. 7,12 Several studies have also revealed the high prevalence of vitamin D deficiency in transplant recipients, 13,14 and this is of great interest in the field as it represents a powerful and modifiable risk factor.…”