Bone Mass and Turnover after Allogeneic Stem Cell Transplantation

A prospective study of bone loss and turnover after allogeneic bone marrow transplantation; effect of calcium supplementation with or without calcitonin. of bone mass and normalization of bone turnover in long-term survivors of allogeneic bone marrow transplantation.tion of bone loss after allogeneic stem cell transplantation by calcium, vitamin -D, and sex hormone replacement with or without pamidronate. 6 ABSTRACT Allogeneic stem cell transplantation (SCT) is an important form of treatment for many haematological diseases. When acute complications, such as infections and graft-versus-host disease, are treatable, more attention is paid to the long-term complications of the procedure. The experience from solid organ transplantations shows that bone loss, osteoporosis and fractures are important complications of these procedures. Consequently, the present study of patients with SCT was undertaken to answer the following questions: I What is the magnitude and timing of bone loss? II What is the mechanism of bone loss as examined by bone turnover markers and serum osteopro-tegerin and RANKL measurements? III Can the bone status of SCT patients improve spontaneously? IV How and by what mechanism does allogeneic SCT performed in childhood affect peak bone mass in adolescence and young adulthood? V Can bone loss be prevented by calcium, vitamin D, calcitonin, sex steroid replacement therapy or bisphosphonates? Altogether 187 patients with allogeneic SCT participated in the studies; 73 healthy individuals served as controls in biochemical measurements. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA). Bone turnover rate was assessed by measuring the markers of bone formation [bone-specific alkaline phosphatase (B-ALP), type I procollagen amino-(PINP) and carboxyterminal propep-tides (PICP) and osteocalcin (OC)] and resorption [cross-linked carboxyterminal tel-opeptide of type I collagen (ICTP), C-terminal cross-linked telopeptide of type I colla-gen (CTX), aminoterminal telopeptide of type I collagen (NTX) and tartrate-resistant acid phosphatase 5 b (TRACP5b)]. During six months after SCT, BMD of the lumbar spine (LS) and the femoral neck (FN) reduced by 5.8 % and 7.0 %, respectively. During the next six months, the LS BMD slightly recovered but the FN BMD further decreased to 8.0%. Thirty-nine per cent of SCT patients had either osteopenia or osteoporosis at the LS before transplan-tation, and the number increased up to 47 % one year after SCT. At the FN, 25 % of patients had a reduced BMD at baseline and 58 % one year after SCT. The markers of bone formation decreased during the first three months but returned …