Changes in bone mineral density after allogenic stem cell transplantation - 21/09/22
, Leonardo Magro b, Adeline Pierache c, Valérie Coiteux b, Ibrahim Yakoub Agha b, Bernard Cortet a, Isabelle Legroux-Gerot aHighlights |
• | Bone fragility occurred in pre- and post-allogenic stem cell transplantation. |
• | The highest bone loss occurred during the first months. |
• | Bone loss is predominant at the hip, where recovery is slower compared to lumbar spine. |
• | Corticosteroid treatment, progressive disease before allogenic stem cell transplantation and bone marrow stem cells are the main factors explaining bone loss. |
Abstract |
Objective |
Osteoporosis is a complication after allogenic stem cell transplantation (alloSCT). The purpose of this study was to assess changes in bone mineral density (BMD) 6 months and 3 years after alloSCT, as well as predictors of bone loss.
Methods |
A longitudinal, prospective, single-center study was conducted at Lille University Hospital between 2005 and 2016. Clinical, biological, radiologic (thoracic and lumbar spine) and densitometric (DXA) assessments were carried out at baseline (pre-transplant), 6 months and 3 years. Patients with myeloma were not included.
Results |
Two hundred and fifty-eight patients were included (144 men). Among them, 60.1% had leukemia and 65.8% of them, acute myeloid leukemia. At baseline, 6 months and 3 years, DXA-confirmed that osteoporosis was observed in 17%, 22.8% and 17.5% of the patients, respectively, mainly at the femoral neck. At baseline, 6 months and 3 years, 9 (8.5%), 53 (21.5%) and 38 (16.7%) patients, respectively, were receiving anti-osteoporotic treatment. From baseline to 6-month follow-up, BMD decreased significantly (p<0.001) at the lumbar spine (−36 [95%CI; −51 to −20] mg/cm2 of hydroxyapatite), femoral neck (−43 [95%CI; −57 to −29] mg/cm2 of hydroxyapatite) and total hip (−53 [95%CI; −68 to −39] mg/cm2 of hydroxyapatite). From 6-month to 3-year follow-up, a significant increase in BMD was observed at the lumbar spine only (+31 [95%CI; 20 to 42] mg/cm2 of hydroxyapatite, p<0.001). At all 3 sites, changes in BMD did not differ between patients treated or untreated by anti-osteoporotic treatment from 6-month to 3 year follow-up. Incident fractures were found in 4.1% and 5.7% of the patients at 6 months and 3 years, respectively. Between baseline and 6 months, bone loss at all 3 sites was associated with corticosteroid intake. At the total hip, 23.3% of the decrease in BMD from baseline to 6 months was due to an active hematological disease (p<0.05), a bone marrow stem cells (p<0.01) and a corticosteroid intake (p<0.01).
Conclusion |
Our study found evidence of bone fragility in alloSCT patients. Low BMD persisted at the hip 3 years after transplantation due to slower improvement at this site.
Le texte complet de cet article est disponible en PDF.Keywords : Osteoporosis, Allogenic stem cells transplantation, Fracture, Bone mineral density
Plan
Vol 89 - N° 5
Article 105373- octobre 2022 Retour au numéro
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