Decreased bone mineral density is common after autologous blood or marrow transplantation

Abstract

Summary:Survivors of autologous blood or marrow transplantation (ABMT) are predisposed to decreased bone mineral density (BMD), but data are lacking on the incidence and risk factors for this condition. Therefore, we measured BMD in 64 of 68 consecutive ABMT survivors (35 men and 29 women) attending the University of Toronto ABMT long-term follow-up clinic. Patients were evaluated a median of 4.2 years (range: 4.9 months-11.4 years) after ABMT. Median age at evaluation was 49.6 years (range: 23.5-68.2 years). At the L1-L4 vertebrae, 17 (26%) patients (eight men and nine women) had osteopenia and one male (2%) had osteoporosis. Mean BMD at L1-L4 did not differ from healthy young adults or age and sex matched controls. At the femoral neck, 30 patients (46%) (18 men and 12 women) had osteopenia and five (8%) (two men and three women) had osteoporosis. Mean BMD at the femoral neck was significantly lower than in healthy young adults and age-and sex-matched controls. By regression analysis, patients with decreased BMD were older than those with normal BMD (P = 0.02). Gender, body mass index, time from BMT to evaluation and presence of hypogonadism were not associated with decreased BMD. Treatment of decreased bone density was instituted and follow-up data were obtained 1 year after treatment in 22 of 39 patients with reduced BMD. Nineteen (86%) patients had stabilization or improvement of their bone density at follow-up. We conclude that, after ABMT, over half of the patients have evidence of osteopenia or osteoporosis. Men and women were equally affected. In our study, only older age at evaluation was predictive for loss of BMD. We recommend the measurement of BMD as an integral component to the follow-up of ABMT patients. Bone Marrow Transplantation (2001) As the number of long-term survivors of autologous blood or marrow transplantation (ABMT) increases, greater attention is turning to the late complications of this procedure. One such complication is decreased bone mineral densityosteopenia and osteoporosis. Osteopenia is a systemic condition characterized by reduced bone mass and increased susceptibility to bone fracture. Osteoporosis is a more severe reduction in bone mass and a greater susceptibility to bone fracture.In the short term, osteoporosis seems trivial compared with a diagnosis of cancer, but for those cured of their disease, decreased bone mineral density contributes to chronic morbidity and mortality in the form of bone fractures. For example, 50% of patients who sustain an osteoporosisrelated hip fracture require assistance with activities of daily living 1 and elderly patients who suffer an osteoporosis-related hip fracture have an increased 1-year mortality of 12-37%. 2 ABMT predisposes to decreased BMD through early and late acting mechanisms. ABMT is associated with an acute increase in bone turnover due to the high-dose chemotherapy, marrow reinfusion and G-CSF administration, but effects on long-term bone density are unknown. [3][4][5] The late effects of ABMT on BMD are primarily due to t...

Significant and persistent loss of bone mineral density in the femoral neck after haematopoietic stem cell transplantation: long‐term follow‐up of a prospective study

“…The demonstration of significant bone loss at the proximal femur, but not at the spine, is consistent with the findings reported by Schimmer et al (2001), and a similar distribution of bone loss has also been documented following liver transplantation (Hussaini et al, 1999;Keogh et al, 1999;Ninkovic et al, 2002). The mechanisms underlying this differential bone loss have not been established nor is it known whether complete recovery of bone mass occurs over longer periods of time.…”

“…Many of these patients are still relatively young at the time of autoSCT and have been exposed to a range of processes that may predispose to bone loss and an increased risk of fragility fractures (Weilbaecher, 2000). A recent cross-sectional analysis in long-term survivors following autoSCT (BMD measured at a median 4AE2 years) found reduced BMD values compared with age-matched healthy control subjects at the femoral neck but not the lumbar spine (Schimmer et al, 2001). Hitherto, however, there have been no large prospective studies addressing this group of transplant recipients.…”

“…Results from a cross-sectional study suggested that BMD loss also occurs in long-term survivors following autoSCT (Schimmer et al, 2001). However, data on the temporal sequence of bone loss are sparse, and at present it is unclear whether bone loss is similar to that observed in patients undergoing alloSCT.…”

Bone metabolism in patients more than five years after bone marrow transplantation

“…In contrast to most previous studies in BMT recipients, 10,11,13,15 no patient in our cohort met the WHO criteria for osteoporosis whereas about one half of our BMT survivors had evidence of osteopenia. So far, only one investigation performed 75 months after allogeneic BMT 14 reported no patient with osteoporosis while 7/26 (27%) survivors had osteopenia.…”

“…Bone mineral density (BMD) measurements about 4 years after autologous blood or marrow transplantation showed that 26 and 2% of patients had osteopenia and osteoporosis at the lumbar spine, respectively, and 46 and 8% of patients had osteopenia and osteoporosis at the femoral neck, respectively. 15 In contrast, Keilholz and co-workers 16 reported no reduction of BMD 5 years after autologous BMT. However, studies on autotransplants may not necessarily be applicable to allotransplant patients, since the latter require immunosuppressive therapy.…”