Changes in bone mineral density and bone turnover markers in patients undergoing hematopoietic stem cell transplant.
BACKGROUND
Hematopoietic stem cell transplant (HSCT) is frequently complicated by endocrine abnormalities and loss of bone mass. This prospective study was conducted to evaluate the bone loss post-HSCT.


METHODS
A total of 50 patients was evaluated pretransplantation, and 25 had HSCT (17 males, 8 females; 19 allogenic, 6 autologous). Bone mineral density (BMD) and bone markers were measured at baseline, 3-6 months and 12 months.


RESULTS
The mean age and body mass index were 25.1 ± 16.3 years and 19.4 ± 4.5 kg/m(2), respectively. There were 15 adults (60%), and 10 adolescents (40%). There was a significant decline in BMD from the baseline at total femur (-8.7%; P < 0.0001), femoral neck (-5.0%; P = 0.003), femoral trochanter (-6.0%; P = 0.001), and Ward's triangle (-9.9%; P < 0.0001) at 6 months posttransplantation. From the 6 months to 12 months, there was a significant improvement in BMD at above sites except at Ward's triangle. The decline in BMD was nonsignificant at the whole body (-0.3%, P = 0.748) and the lumbar spine (-2.7%, P = 0.130) at 6 months posttransplant. Younger patients with allogenic graft and steroid use are more likely to have significant loss of BMD at hip posttransplant. Serum osteocalcin decreased, and N-telopeptide increased at 3-6 months, which return to baseline at 1-year posttransplant.


CONCLUSIONS
A significant bone loss is observed at 6 months in patients with post-HSCT. The bone loss occurs predominantly at cortical bone. There is recovery of bone mass at 12 months posttransplant except at Ward's triangle. Bone loss after HSCT is multifactorial.
Commandant, Military Hospital, Shillong, Meghalaya,, India.
Aditi
A
Pandit
Commandant, Military Hospital, Shillong, Meghalaya,, India.
M K
MK
Garg
Department of Endocrinology, Army Hospital Research and Referral, New Delhi, India.
N
N
Kotwal
Department of Endocrinology, Army Hospital Research and Referral, New Delhi, India.
K S
KS
Brar
Department of Endocrinology, Army Hospital Research and Referral, New Delhi, India.
Abhay
A
Gundgurthi
Department of Hematology, Army Hospital Research and Referral, New Delhi, India.
A K
AK
Sharma
Department of Hematology, Army Hospital Research and Referral, New Delhi, India.
Sanjeevan
S
Sharma
Bone markers; bone mineral density; hematopoietic stem cell transplant