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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

Bone Marrow Transplantation volume 52, pages 663–670 (2017)Cite this article

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Abstract

The most effective method to prevent and treat bone loss following hematopoietic stem cell transplantation (HSCT) remains uncertain. We conducted a comprehensive search in four electronic databases until August 2015. We retrieved articles describing patients with bone loss or fractures who received HSCT. Controlled trials, with a follow-up period of at least 12 months, were included. Twelve studies (19 publications) met our inclusion criteria. A total of 643 participants underwent HSCT (85.7% allogeneic HSCT). There was a statistically significant lower mean bone mineral density (g/cm2) percentage change of the lumbar spine (mean difference (MD) 7.8, 95% confidence interval (CI) 5.6–10.0) and femoral neck (MD 6.7, 95% CI 5.6–7.9) in the bisphosphonate therapy group compared with the control group with no bisphosphonate therapy at 12 months. In a subgroup analysis, seven different comparison groups were evaluated. The rate of fractures or X-ray findings of subclinical vertebral fractures was similar between groups. Bisphosphonates are promising in the prevention and treatment of bone loss following HSCT. Additional research is required to determine whether they reduce long-term fracture risk.

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Acknowledgements

We are grateful to Dr Gregory Pratt from the Research Medical Library of the University of Texas MD Anderson Cancer Center for conducting the search in the electronic databases. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author contributions

Dr Suarez-Almazor had full access to all of the data in the study and takes responsibility for the integrity and the accuracy of the data analysis. Study concept and design: Suarez-Almazor and Lu; search strategy: Pratt; selection of the studies: Cheema, Sanchez Petitto, Pundole and Lopez-Olivo; quality appraisal and data extraction: Cheema, Sanchez Petitto, Pundole and Lopez-Olivo; analysis and interpretation of data: Cheema, Sanchez Petitto, Pundole, Lopez-Olivo, Lu and Suarez-Almazor; drafting of the manuscript: Cheema, Pundole, Lu and Lopez-Olivo; critical revision of the manuscript for important intellectual content: Cheema, Sanchez Petitto, Pundole, Lopez-Olivo, Lu and Suarez-Almazor; administrative, technical or material support: Suarez-Almazor; study supervision: Suarez-Almazor.

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Authors and Affiliations

  1. Department of General Internal Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    X Pundole, H I Cheema, G Sanchez-Petitto, M A Lopez-Olivo, M E Suarez-Almazor & H Lu

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  1. X Pundole
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Correspondence to H Lu.

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Competing interests

Dr Lopez-Olivo reports grants from Rheumatology Research Foundation, outside the submitted work. Dr Suarez-Almazor reports advisory/consulting role for Ardea Biosciences and a Pfizer Aspire Grant, outside the submitted work.

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Pundole, X., Cheema, H., Sanchez-Petitto, G. et al. Prevention and treatment of bone loss and fractures in patients undergoing a hematopoietic stem cell transplant: a systematic review and meta-analysis. Bone Marrow Transplant 52, 663–670 (2017). https://doi.org/10.1038/bmt.2016.312

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