The short-term changes of bone mineral metabolism following bone marrow transplantation

Organ transplantation is now the treatment of choice for many patients with life-threatening chronic diseases, A new set of side effects unique to the se groups of patients has become recognized, and bone disease is one of the se complications. However, little is known about the effects of myeloablati ve treatment followed by bone marrow transplantation (BMT) on bone mineral metabolism, We have prospectively investigated 31 patients undergoing BMT f or hematologic diseases. Serum concentrations of calcium, phosphorus, creat inine, gonadotropins, sex hormones, and the biochemical markers of bone tur nover were measured. The samples were collected before BMT and 1, 2, 3, 4, and 12 weeks, 6 months, and 1 year after BMT, Bone mineral density (BMD) wa s measured with dual-energy X-ray absorptiometry before BMT and 1 year afte r BMT. The serum carboxy-terminal cross-linked telopeptide of type I collag en increased progressively until 4 weeks after BMT. Thereafter, it began to decrease and reached basal values after 1 year, Serum osteocalcin decrease d progressively until 3 weeks after BMT. After that, it increased and reach ed basal values after 3 months. No distinct differences were observed in th e serum biochemical turnover markers between males and females, or between patients who received total body irradiation and those who did not. One yea r after BMT, lumbar spine BMD had decreased by 2.2%, and total proximal fem oral BMD had decreased by 6.2%. Eighty-six percent of the women (12/14) wen t into a menopausal state immediately after BMT, This was caused by high go nadotropin levels and low estradiol levels. In contrast, gonadotropin level s and testosterone levels did not change significantly in the male patients after BMT. In conclusion, the rapid impairment of bone formation and the i ncrease in bone resorption, as shown by the biochemical markers in this stu dy, might play a role in post-BMT bone loss. (C) 2000 by Elsevier Science I nc. All rights reserved.