Bone density loss after allogeneic hematopoietic stem cell transplantation: A prospective study

The incidence and course of bone density abnormalities following hematopoie tic stem cell transplantation are poorly understood and complicated by the impact of multiple factors. Hip, spine, and wrist bone mineral densities (B MDs) were measured in 104 adults (54 women, 54 men; mean age, 40 years [ran ge, 18-64 years]) at 3 and 12 months after allogeneic transplantation. Clin ical and laboratory variables were evaluated using univariate and multivari ate analyses to determine risk factors for osteoporosis, fracture, and avas cular necrosis. At 3 months posttransplantation, combined (male and female) hip, spine, and wrist z scores were -0.35, -0.42, and +0.04 standard devia tions, respectively. At 12 months both men and women experienced significan t loss of hip BMD (4.2%, P < .0001); changes in the spine and wrist were mi nimal. The cumulative dose and number of days of glucocorticoid therapy and the number of days of cyclosporine or tacrolimus therapy showed significan t associations with loss of BMD; age, total body irradiation, diagnosis, an d donor type did not. Nontraumatic fractures occurred in 10.6% of patients and avascular necrosis in 9.6% within 3 years posttransplantation. The decr ease in height between pretransplantation and 12 months posttransplantation was significant (P = .0001). Results indicate that loss of BMD after allog eneic stem cell transplantation is common and accelerated by the length of immunosuppressive therapy and cumulative dose of glucocorticoid. An increas ed incidence of fracture and avascular necrosis may adversely impact long-t erm quality of life. Prevention of bone demineralization appears warranted after stem cell transplantation.