Prevention and treatment of bone loss and fractures in patients undergoing a hematopoietic stem cell transplant: a systematic review and meta-analysis

Pundole, Xerxes; Cheema, Hira; Petitto, Gabriela Sanchez; López-Olivo, María A.; Suarez‐Almazor, María E.; Lü, Huifang

doi:10.1038/bmt.2016.312

Cited by 25 publications

(16 citation statements)

References 30 publications

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“…In summary, bisphosphonates generally prevented bone loss [98,101] or increased bone mass [97,102]. A metaanalysis confirmed that bisphosphonates, and in particular, zoledronic acid, are promising in the prevention of HSCTinduced bone loss [28].…”

Section: Bisphosphonatesmentioning

confidence: 83%

“…The relative risk was increased eightfold and seven-to ninefold, in women and men, respectively, compared with 45-to 64-year-old individuals from two population-based cohorts [26,27]. A substantial number of patients with multiple myeloma, who are known to be a risk of fracture independently of transplant, were included in this study [28]. The risk was higher in allogeneic than in autologous HSCT [27].…”

Section: Epidemiology Of Osteoporosis and Fracture In Adult Patients mentioning

confidence: 99%

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Bone management in hematologic stem cell transplant recipients

et al. 2018

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Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for patients with some malignant and non-malignant hematological diseases. Advances in transplantation techniques and supportive care measures have substantially increased the number of long-term HSCT survivors. This has led to an increasing patient population suffering from the late effects of HSCT, of which, bone loss and its consequent fragility fractures lead to substantial morbidity. Altered bone health, with consequent fragility fractures, and chronic graft-versus-host disease (GVHD) are factors affecting long-term quality of life after HSCT. Hypogonadism, HSCT preparative regimens, nutritional factors, and glucocorticoids all contribute to accelerated bone loss and increased fracture risk. Management strategies should include bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures. Evidence has accumulated permitting recommendations for more attentiveness to evaluation and monitoring of bone health, with appropriate application of osteoporosis pharmacotherapies to patients at increased risk of bone loss and fracture.

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Section: Bisphosphonatesmentioning

confidence: 83%

Section: Epidemiology Of Osteoporosis and Fracture In Adult Patients mentioning

confidence: 99%

Bone management in hematologic stem cell transplant recipients

et al. 2018

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“…103 Overall, bisphosphonates, in particular zoledronic acid, have been shown to be effective at preventing HCT-induced bone loss. 122 Currently, there is insufficient data to recommend one agent over the other, treatment frequency, or initiation timeframe. The appropriate duration of antiresorptive therapy is unclear and investigators have studied a treatment duration range between 3 and 60 months.…”

Section: Skeletal Complicationsmentioning

confidence: 99%

Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

et al. 2020

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Annually, ~50,000 patients undergo hematopoietic stem cell transplantation (HCT) worldwide with almost 22,000 of these patients receiving HCT in the United States. HCT is a curative option for a wide range of hematologic malignancies, and advances in transplantation medicine have resulted in an increase in HCT survivors. It is anticipated that the number of HCT survivors will more than double from 242,000 in 2020 to ~500,000 in 2030. Survivors of HCT are at an increased risk of developing late complications due to exposure to chemotherapy and/or radiation in the pre‐, peri‐, and post‐HCT phases and these cumulative exposures have the potential to damage normal tissue. This tissue damage leads to the early onset of chronic health conditions resulting in premature mortality in HCT survivors, who have a 15‐year cumulative incidence of severe or life‐threatening chronic health conditions exceeding 40%. Due to the significant burden of morbidity in HCT survivors and the delay in the development of long‐term complications, this delicate patient population requires life‐long monitoring due to the risk for neuropsychological, cardiac, pulmonary, renal, hepatic, ocular, skeletal, cardiac, endocrine, fertility, and sexual health complications, as well as secondary neoplasms. This review will focus on recent advances in screening, monitoring, and therapeutics for late‐occurring or long‐term complications in HCT survivors.

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“…With improvements in stem cell transplant methodologies, long‐term survivorship has increased, but has brought with it attendant problems including increases in skeletal fragility and fracture risk, reflecting multiple factors including conditioning regimens, glucocorticoid use, deficits in nutritional support and often prolonged periods of hypogonadism . In addition to clinical risk factor assessment, the judicious use of anti‐resorptive therapies, particularly intravenous bisphosphonates, has been shown to limit bone loss, typically when provided at dosing schedules more intensive than those used for the treatment of osteoporosis . No clinical trials on the use of denosumab in patients undergoing bone marrow transplant have yet been reported.…”

Section: Haematologic Malignanciesmentioning

confidence: 99%

The skeletal impact of cancer therapies

Bedatsova

Drake

2019

Brit J Clinical Pharma

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Both cancer and therapies used in the treatment of cancer can have significant deleterious effects on the skeleton, increasing the risks for both bone loss and fracture development. While advancements in cancer therapies have resulted in enhanced cancer survivorship for patients with many types of malignancies, it is increasingly recognized that efforts to reduce bone loss and limit fractures must be considered for nearly all patients undergoing cancer therapy in order to diminish the anticipated future skeletal consequences. To date, most studies examining the impact of cancer therapies on skeletal outcomes have focused on endocrine-associated cancers of the breast and prostate, with more recent advances in our understanding of bone loss and fracture risk in other malignancies. Pharmacologic efforts to limit the adverse effects of cancer therapies on bone have nearly universally employed anti-resorptive approaches, although studies have frequently relied on surrogate outcomes such as changes in bone mineral density or bone turnover markers, rather than on fractures or other skeletal-related events, as primary study endpoints. Compounding current deficiencies for the provision of optimal care is the recognition that despite clearly written and straightforward society-based guidelines, vulnerable eligible patients are very often neither identified nor provided with appropriate treatments to limit the skeletal impact of their cancer therapies. KEYWORDS androgen deprivation therapy, aromatase inhibitor, bone loss, breast cancer, myeloma, prostate cancer

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Prevention and treatment of bone loss and fractures in patients undergoing a hematopoietic stem cell transplant: a systematic review and meta-analysis

Cited by 25 publications

References 30 publications

Bone management in hematologic stem cell transplant recipients

Bone management in hematologic stem cell transplant recipients

Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

The skeletal impact of cancer therapies

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