title: Bisphosphonate therapy for reduced bone mineral density in children with chronic graft-versus-host disease.
abstract: Reduced bone mineral density (BMD) occurs frequently in children after hematopoietic cell transplantation (HCT), but therapy for this complication is undefined. To determine the impact of bisphosphonate therapy on reduced BMD after HCT, we compared baseline and follow-up dual energy X-ray absorptiometry (DEXA) scans of 48 patients (controls) who received calcium and vitamin D to 18 patients who also received bisphosphonate therapy. Among the controls, median annualized increase in standardized BMD (sBMD) was 10% (range, -26% to +41%), but the deviation of sBMD from normal, as indicated by the Z-score, did not improve from baseline, -2.46 (range: -5.15 to -1.16) compared to follow-up, -2.79 (range: -5.76 to +0.07). For the bisphosphonate-treated patients, the median annualized increase in sBMD was 33% (range 3% to 147%, P = .0002) and the median Z-score improved from -3.57 (range: -5.13 to -0.86) at baseline, to -1.80 (-4.89 to +0.47) at follow-up (P = .06). The annualized median change in BMD Z-scores per year was +0.12 (-2.28 to +4.24) among the controls and +1.43 (-0.29 to +3.72) for the bisphosphonate group (P = .0002). The greatest improvement in BMD was observed in children who received therapy with bisphosphonates.
authors.affiliation: Fred Hutchinson CRC, Seattle, Washington, USA. pcarpent@fhcrc.org
authors.forename: Paul A
authors.initials: PA
authors.lastname: Carpenter
authors.forename: Paul
authors.initials: P
authors.lastname: Hoffmeister
authors.forename: Charles H
authors.initials: CH
authors.lastname: Chesnut
authors.forename: Barry
authors.initials: B
authors.lastname: Storer
authors.forename: Paula M
authors.initials: PM
authors.lastname: Charuhas
authors.forename: Ann E
authors.initials: AE
authors.lastname: Woolfrey
authors.forename: Jean E
authors.initials: JE
authors.lastname: Sanders
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D002118:Calcium / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000008:administration & dosage* / Q000633:toxicity; D004341:Drug Evaluation; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D004164:Diphosphonates; D014807:Vitamin D; D002118:Calcium