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Early changes in bone mineral density and trabecular bone score following allogeneic stem cell transplant

Bone Marrow Transplantation volume 51, pages 738–740 (2016)Cite this article

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Advances in allogeneic stem cell transplant (allo-SCT) have resulted in improved patient survival and increased recognition of long-term complications of transplant, including bone loss. Allo-SCT is associated with multiple factors that may adversely impact bone including chemotherapy, TBI, gonadal failure, calcineurin inhibitor and glucocorticoid exposure.1 The impact of the intensity of conditioning chemotherapy, however, has not been extensively studied.2 Previous studies have shown that the most profound bone mineral density (BMD) decline occurs within the first 6 months following allo-SCT3, 4 but information regarding earlier change is limited.2, 3 Declines in BMD are greater at the femoral neck, a site rich in cortical bone, than lumbar spine, a site rich in trabecular bone, and this may suggest disproportionate cortical bone loss.1, 3, 4, 5 This pattern is unlike the early spine BMD decline generally seen in postmenopausal and glucocorticoid-induced osteoporosis and suggests a unique mechanism. In addition, qualitative microstructural properties also affect bone strength and fracture risk. However, previous studies have not examined the impact of allo-SCT on bone quality.

According to our standard procedures, patients undergoing allo-SCT have BMD assessed by dual x-ray absorptiometry (DXA) at baseline and 100 days after transplantation (d100). We evaluated BMD change at d100 in 137 of 236 patients who had allo-SCT (between 2011-2014) and had paired DXA scans. Paired scans were not available for 97 patients; 65 missing baseline scan, 14 patients died and 18 patients did not return for d100 scan. Two patients were treated with zoledronic acid following baseline DXA and were excluded from the analysis. BMD was defined according to WHO (World Health Organization) T-score criteria: ⩽−2.5 osteoporosis,<−1.0 and >−2.5 osteopenia, and ⩾−1.0 normal bone density.6 We sought to identify patient- and transplant-specific factors associated with BMD loss to inform patient selection for antiresorptive therapy; patient characteristics are presented in Table 1. We also measured change in trabecular bone score (TBS), an indirect measure of lumbar spine bone microarchitecture and independent predictor of fracture risk.7 TBS was determined for L1–L4: TBS ⩾1.350 normal; 1.200–1.350 partially degraded; <1.200 degraded trabecular microarchitecture.7 Throughout the transplant period, patients were prescribed 1200 mg elemental calcium, and 2000 IU vitamin D daily. Cyclosporine and short course methotrexate or mycophenolate mofetil were used for prevention of GvHD. Prednisone (2 mg/kg) was used for first-line treatment of grades II–IV acute GvHD.

Table 1 Study patient characteristics
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Authors and Affiliations

  1. Department of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada

    M Pawlowska & D L Kendler

  2. Prohealth Clinical Research, Vancouver, British Columbia, Canada

    Q Yang

  3. Department of Family Medicine, University of British Columbia, Prince George, British Columbia, Canada

    B Hamata

  4. Department of Hematology, University of British Columbia, Leukemia BMT Program of British Columbia, Vancouver, British Columbia, Canada

    R Broady

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  1. M Pawlowska
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  2. Q Yang
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  3. B Hamata
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  4. D L Kendler
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Correspondence to M Pawlowska.

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Competing interests

DLK declares research grants, consultancies and /or speakers’ honoraria from Amgen, Eli Lilly, GSK, Pfizer, Astrazenica, Astalis and Merck. The remaining authors declare no conflict of interest.

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Pawlowska, M., Yang, Q., Hamata, B. et al. Early changes in bone mineral density and trabecular bone score following allogeneic stem cell transplant. Bone Marrow Transplant 51, 738–740 (2016). https://doi.org/10.1038/bmt.2015.329

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