title: Prospective assessment of bone turnover and clinical bone diseases after allogeneic hematopoietic stem-cell transplantation.
abstract: BACKGROUND
  Bone complications after hematopoietic stem-cell transplantation (HSCT) are relatively frequent. Evaluation of biomarkers of bone turnover and dual energy x-ray absorptiometry (DEXA) are not known in this context.
  
  
  METHODS
  We prospectively evaluated bone mineral density, biomarkers of bone turnover, and the cumulative incidence of bone complications after allogeneic HSCT. One hundred forty-six patients were included. Bone mineral density was measured by DEXA 2-month and 1-year post-HSCT. The markers of bone turnover were serum C-telopeptide (C-TP), 5 tartrate-resistant acid phosphatase (bone resorption), and osteocalcin (bone formation) determined pre-HSCT and 2 months and 1 year thereafter. Potential association between osteoporosis at 2 months, osteoporotic fracture or avascular necrosis and, individual patient's characteristics and biologic markers were tested.
  
  
  RESULTS
  C-TP was high before and 2 months after transplant. At 2 months, DEXA detected osteoporosis in more than half the patients tested. Male sex, median age less than or equal to 15 years, and abnormal C-TP before HSCT were risk factors significantly associated with osteoporosis. Three-year cumulative incidences of fractures and avascular necrosis were 8% and 11%, respectively. Children were at higher risk of fracture, whereas corticosteroid treatment duration was a significant risk factor for developing a clinical bone complication post-HSCT. Bone complications and osteoporosis are frequent after HSCT. Bone biologic markers and DEXA showed that subclinical bone abnormalities appeared early post-HSCT.
  
  
  CONCLUSIONS
  The risk factors, age, gender, and C-TP easily available at the time of transplantation were identified. Biphosphonates should probably be given to patients with those risk factors.
authors.affiliation: Service d'Etaématologie-Greffe, Hôpital Saint-Louis, AP-HP, Université Paris VII, Paris, France.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Petropoulou
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Andrée-Laure
authors.initials: AL
authors.lastname: Herr
authors.forename: Agnès
authors.initials: A
authors.lastname: Devergie
authors.forename: Thomas Funck
authors.initials: TF
authors.lastname: Brentano
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Fernando O
authors.initials: FO
authors.lastname: Pinto
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: Philippe
authors.initials: P
authors.lastname: Orcel
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
mesh_terms: D000293:Adolescent; D000328:Adult; D015519:Bone Density; D001847:Bone Diseases / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D001842:Bone and Bones / Q000378:metabolism*; D002648:Child; D024042:Collagen Type I / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D009336:Necrosis; D010455:Peptides / Q000097:blood; D012307:Risk Factors; D012727:Sex Characteristics; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000502:physiology*; D014916:Whole-Body Irradiation / Q000009:adverse effects
chemical_list: D024042:Collagen Type I; D007166:Immunosuppressive Agents; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D016572:Cyclosporine