Bone mineral density and osteonecrosis in survivors of childhood allogeneic bone marrow transplantation

Abstract

Summary:Our purpose was to evaluate frequency and severity of bone mineral decrements and frequency of osteonecrosis in survivors of pediatric allogeneic bone marrow transplantation (alloBMT). We retrospectively reviewed demographic information, treatment, magnetic resonance (MR) imaging studies (hips and knees), and bone mineral density (BMD) studies of 48 patients as measured by quantitative computed tomography (QCT). In all, 24 patients were male; 37 were Caucasian. Median age at alloBMT was 10.3 years (1.6-20.4 years). Of the 48 patients, 43 underwent QCT. Median time between alloBMT and imaging was 5.1 years (1.0-10.2 years). Median BMD Z-score was À0.89 (À4.06 to 3.05). BMD Z-score tended to be associated with female sex (P ¼ 0.0559) but not with age at BMT, race, primary diagnosis, time from alloBMT, T-cell depletion of graft, total-body irradiation, or acute/chronic graft-versus-host disease (GVHD). MR showed osteonecrosis in 19 of 43 (44%). We found no associations between osteonecrosis and sex, race, diagnosis, age at BMT, history of GVHD, time from BMT, or T-cell depletion. Seven patients (15%) had MR changes of osteonecrosis and BMD Z-scores of less than -1 s.d. We conclude that pediatric alloBMT survivors have decreased BMD and are at risk of osteonecrosis. They should be monitored to assure early intervention that may ameliorate adverse outcomes.

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

“…Quantitative computed tomography enables measurement of the 'true' BMD. Kaste et al 13 measured vertebral BMD by quantitative computed tomography in 43 patients with a median of 5.1 years after allo-SCT in childhood and found that 11 patients had osteopenia and nine patients had osteoporosis (thus 47% had osteopenia or osteoporosis), that is, indeed higher prevalence numbers than in studies using areal BMD, including the present one. Another limitation of the present study is the rather small sample size, which restricts statistical power.…”

“…5,[11][12][13][14] We present a study of areal BMD after SCT that constitutes the longest follow-up published to date (median 18.2 years) and in which all patients had reached final height. BMD total BMD femneck and BMD totalhip were significantly lower among the patients compared with the controls, but there was no significant difference in BMD lumbar This is consistent with data showing a preferential recovery of BMD in the lumbar spine after SCT.…”

“…[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. Most patients had undergone auto-SCT and none had experienced cGVHD.…”

Childhood to adult transition and long-term follow-up after blood and marrow transplantation

“…50 Pediatric BMT survivors have decreased bone mineral density and are at higher risk of fracture, osteonecrosis and osteoporosis (particularly females). [50][51][52][53][54] Avascular necrosis of bone occurs in more than 10% of BMT survivors. 54 Endocrine arrest of bone development refers to the decreased growth in childhood BMT survivors due to BMT conditioning and GVHD treatment.…”

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

“…6 It has been described after hematopoietic stem cell transplantation (SCT) as well, with the majority of cases reported in alloSCT recipients. [7][8][9][11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][27][28][29][30][31][32][33][34][35] AlloSCT-associated BMD loss is usually described in the first 6-12 months after the transplantation, but varies widely from 40 days 17 to 4-6 years after the transplantation, 30,31,34 and in some instances can persist for 10-12 years. 26,28 Baseline BMD pre-SCT is usually within the normal limits; [15][16][17]24,[27][28][29][30]33 the few exceptions noting high O/O prevalence pre-SCT are probably due to the underlying diseases or intensive chemotherapy prior to the transplantation.…”