Prospective assessment of bone turnover and clinical bone diseases after allogeneic hematopoietic stem-cell transplantation.
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.
Petropoulou
Anna D
AD
Service d'Etaématologie-Greffe, Hôpital Saint-Louis, AP-HP, Université Paris VII, Paris, France.
Porcher
Raphael
R
Herr
Andrée-Laure
AL
Devergie
Agnès
A
Brentano
Thomas Funck
TF
Ribaud
Patricia
P
Pinto
Fernando O
FO
Rocha
Vanderson
V
Peffault de Latour
Régis
R
Orcel
Philippe
P
Socié
Gérard
G
Robin
Marie
M
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
D024042:Collagen Type I; D007166:Immunosuppressive Agents; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D016572:Cyclosporine