title: Effects of allogeneic bone marrow transplantation on recipient bone mineral density: A prospective study.
abstract: 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.
authors.affiliation: Division of Hematology/Bone Marrow Transplantation City of Hope National Medical Center, Duarte, California 91010, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kashyap
authors.forename: F
authors.initials: F
authors.lastname: Kandeel
authors.forename: D
authors.initials: D
authors.lastname: Yamauchi
authors.forename: J M
authors.initials: JM
authors.lastname: Palmer
authors.forename: J C
authors.initials: JC
authors.lastname: Niland
authors.forename: A
authors.initials: A
authors.lastname: Molina
authors.forename: H
authors.initials: H
authors.lastname: Fung
authors.forename: R
authors.initials: R
authors.lastname: Bhatia
authors.forename: A
authors.initials: A
authors.lastname: Krishnan
authors.forename: A
authors.initials: A
authors.lastname: Nademanee
authors.forename: M R
authors.initials: MR
authors.lastname: O'Donnell
authors.forename: P
authors.initials: P
authors.lastname: Parker
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez
authors.forename: D
authors.initials: D
authors.lastname: Snyder
authors.forename: R
authors.initials: R
authors.lastname: Spielberger
authors.forename: A
authors.initials: A
authors.lastname: Stein
authors.forename: J
authors.initials: J
authors.lastname: Nadler
authors.forename: S J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: 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*
chemical_list: D000970:Antineoplastic Agents; D008903:Minerals