Dramatic improvement of BMD following vitamin D therapy in a bone marrow transplant recipient.
Bone marrow transplantation is now an established successful treatment for several hematologic malignancies. Bone loss is among the long-term adverse effects of this procedure. The underlying pathophysiology is believed to be multifactorial. We report a case of osteoporosis in a young patient who underwent allogenic bone marrow transplantation for acute lymphoblastic leukemia that was complicated by intestinal graft-versus- host disease. Her bone density measurement showed T-scores of -3.46 and -2.47 in the lumbar spine and femoral neck respectively. On evaluation, she had low normal serum calcium, low urine calcium, low 25- hydroxyvitamin D, elevated total and bone specific alkaline phosphatases, and elevated parathyroid hormone. Following treatment with calcifediol, the biochemical markers normalized and the bone mineral density increased by 88% in the lumbar spine and almost 60% in the femoral neck, both of which were above the mean for her age group. We believe that the graft-versus-host disease caused a malabsorptive state that led to vitamin D deficiency and possible resistance and consequent osteomalacia.
D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000502:physiology; D002112:Calcifediol / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications; D006801:Humans; D010018:Osteomalacia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy
D002112:Calcifediol