Effects of allogeneic bone marrow transplantation on recipient bone mineral density: A prospective study.
Allogeneic bone marrow transplant (BMT) recipients have many known risk factors for developing decreased bone mineral density (BMD) after transplantation. We performed a prospective sequential evaluation of BMD in the lumbar spine and nondominant hip using dual-energy x-ray absorptiometry (DEXA) in a cohort of 47 adult patients (median age, 43 years) who were undergoing radiation-based BMT for hematologic malignancies. Baseline DEXA studies were performed before BMT and repeated at 3 to 4 months, 6 to 8 months, and 12 to 14 months after BMT. The majority of patients (60%) had been minimally treated with combination cytotoxic chemotherapy, having received no more than 1 treatment regimen before BMT. Graft-versus-host disease prophylaxis consisted of cyclosporine in combination with either methotrexate or prednisone, or both. Mean lumbar spine and hip BMD were normal before BMT (spine: 1.01 g/cm2, z score = 96%; hip: 0.86 g/cm2, z score = 100%) and gradually decreased (spine: 0.98 g/cm2, z score = 94%; hip: 0.76 g/cm2, z score = 91%) at 12 to 14 months. These declines were statistically significant (P < .006 and < .002 for lumbar spine; P < .001 and < .001 for hip). In addition, the sharpest decline occurred during the first 6 months after BMT and was more marked in the hip than the lumbar spine. These data suggest that BMT adversely affects BMD in this patient population.
Kashyap
A
A
Division of Hematology/Bone Marrow Transplantation City of Hope National Medical Center, Duarte, California 91010, USA.
Kandeel
F
F
Yamauchi
D
D
Palmer
J M
JM
Niland
J C
JC
Molina
A
A
Fung
H
H
Bhatia
R
R
Krishnan
A
A
Nademanee
A
A
O'Donnell
M R
MR
Parker
P
P
Rodriguez
R
R
Snyder
D
D
Spielberger
R
R
Stein
A
A
Nadler
J
J
Forman
S J
SJ
D015502:Absorptiometry, Photon; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001842:Bone and Bones / Q000737:chemistry; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000628:therapy; D006621:Hip Joint / Q000473:pathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000032:analysis; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000628:therapy; D009196:Myeloproliferative Disorders / Q000188:drug therapy / Q000628:therapy; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D044469:Racial Groups; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000009:adverse effects*
D000970:Antineoplastic Agents; D008903:Minerals