1. ¹Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2. ²Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
3. ³Hallym University, College of Medicine, Chunchon, Korea
4. ⁴Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
5. ⁵Department of Internal Medicine, Miz Medi Hospital, Seoul, Korea

Correspondence: Dr M-I Kang, Division of Endocrinology and Metabolism, Department of Internal Medicine, St Mary's Hospital, The Catholic University of Korea, #62 Yoido-dong Youngdeungpo-Gu, Seoul 150-010, Korea. E-mail: mikang@catholic.ac.kr

⁶These authors contributed equally to the work reported and both should be considered as first authors

Received 29 June 2003; Accepted 9 March 2004; Published online 31 May 2004.

Abstract

Cytokines including IL-6 and TNF- play an important role in the pathogenesis of postmenopausal osteoporosis. However, the relationship between changes in the cytokine levels and subsequent bone loss in patients undergoing a bone marrow transplantation (BMT) is unclear. A total of 46 patients undergoing an allogeneic BMT were prospectively investigated. The bone turnover markers and the serum cytokines were measured before BMT and serially after BMT. Bone mineral density (BMD) was measured before and 1 year after BMT. At 1 year after BMT, the lumbar spine BMD had decreased by 4.8%, and the total proximal femoral BMD had decreased by 12.3%. The serum IL-6 and TNF- levels increased until 2 and 3 weeks after BMT, respectively. The lumbar BMD was significantly decreased as the serum IL-6 and TNF- levels increased by post-BMT 3 weeks. The lumbar BMD decreased significantly as the cumulative prednisolone and cyclosporine dose increased. Patients with GVHD grade II had higher lumbar bone loss than patients with GVHD <grade I. In conclusion, immunosuppressants, GVHD occurrence and increase in bone-resorbing cytokines in the early post-BMT period were associated with later bone loss after BMT. Further studies are needed to elucidate the precise mechanism.