Loss of bone mass and vitamin D deficiency after hematopoietic stem cell transplantation: standard prophylactic measures fail to prevent osteoporosis

Bone mineral density (BMD) and biochemical markers of bone metabolism were analyzed In 67 adults with ALL (n = 27), AML (n = 14), MDS (n = 6) and CML (n = 20) before and after allogeneic stem cell transplantation (SCT). Media n age was 36 years (17-56). Twenty-six out of 53 patients (49%) had osteope nia and osteoporosis before SCT, 21/26 had acute leukemias and 5/26 had chr onic myeloid leukemia (CIVIL). T-score before SCT was -1.23 in patients wit h acute leukemias and 0.62 in CIVIL patients (P = 0.001). After SCT, a sign ificant loss of BMD was observed In all patients. After 6 months, 24 of 36 evaluable patients (67%) had pathologic BMD, 11 of them (30%) had developed osteoporosis. After 12 months, 20 of 32 evaluable patients (62%) had BMD v alues below normal and nine of them (28%) had osteoporosis. Increased pyrid inium excretion was observed in 12/20 patients (60%) with acute leukemias, but only In 3/13 (23%) with CML (P = 0.014). A prolonged vitamin D deficien cy for more than 6 months developed early after SCT In all patients. Patien ts with acute leukemias frequently have osteopenia and osteoporosis before SCT. After SCT, a further loss of BMD occurs independent from the underlyin g disease. Standard prophylactic measures are not sufficient to prevent los s of bone mass. Studies on prophylactic interventions are needed to prevent severe osteoporosis in long-term survivors of SCT.