1. ¹Department of Physical Medicine and Rehabilitation, University of Vienna, Vienna, Austria
2. ²Department of Internal Medicine I, University of Vienna, Vienna, Austria
3. ³Hospital Barmherzige Brueder, Vienna, Austria
4. ⁴Department of Radiology, Osteology, University of Vienna, Vienna, Austria
5. ⁵Department of Biochemistry, University of Vienna, Vienna, Austria
6. ⁶Department of Pathophysiology, University of Vienna, Vienna, Austria

Correspondence: Dr P Pietschmann, Department of Pathophysiology, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail: Peter.Pietschmann@akh-wien.ac.at

⁷Both authors contributed equally to the paper and deserve to be ranked as senior authors.

Received 19 January 2004; Accepted 3 May 2004; Published online 2 August 2004.

Abstract

We investigated the bone metabolism of 22 patients (median age 38 years) over 6 years after allogeneic bone marrow transplantation (BMT). Biplanar roentgenograms of the thoracic and lumbar spine were used to diagnose vertebral deformities caused by fractures. The actual bone mineral density (BMD) of the lumbar spine and the femoral neck were measured. Laboratory tests included calcium, phosphate, parathyroid hormone, a marker of bone resorption (beta-crosslaps, CTX), markers of bone formation (osteocalcin, bone-specific alkaline phosphatase), osteoprotegerin (OPG) – an antagonist of the osteoclast differentiation factor RANKL, and sex hormone status. One patient had a vertebral fracture. Seven patients (28%) had osteopenia in the lumbar spine while 12 patients (48%) had osteopenia in the femoral neck. Bone resorption was increased in nine patients (43%) and bone formation was increased in four patients (20%). BMT recipients had significantly increased serum levels of OPG (P=0.029). Three women (75%) and four men (25%) were hypogonadal. The data showed that BMD is reduced and bone metabolism is still disturbed more than 6 years after BMT. The RANKL/osteoprotegerin system appears to play an important role in the pathophysiology of late post transplantation osteoporosis.