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Alert Number 16

Bone Loss after Stem Cell Transplants

Date: April 30, 2004

The latest issue of the journal "Blood" highlights one of the long-term risks of bone marrow (stem cell) transplants that is often overlooked. Immune suppressive drugs used in allogeneic bone marrow transplants include steroids, used to prevent rejection of the graft. One of the better documented side effects of long term and/or heavy dose use of steroidal drugs (such as prednisone, dexamethasone etc) is the leaching out of calcium from bones, leading to osteoporosis. This leads to brittle bones and risk of fractures. It would be a shame to have to deal with debilitating hip fractures and the like, after you have gone through the tough haul of bone marrow transplant.

There are several modern drugs on the market that deal with osteoporosis. You might have heard of "Fosamax", and there is now a next generation drug called "Zometa". Fosamax has pretty extensive safety record of use in post-menopausal women, and you might be interested to know that Zometa has been approved for fighting cancer related hypercalcemia, including in blood cancers such as multiple myeloma. One of the effects of leaching out of calcium from bones is that it increases the level of calcium in the blood, the resulting hypercalcemia can be a potentially life threatening complication.

Another reason for bone loss is lack of exercise and poor muscle tone. This is something we all need to be aware of, not just those with CLL or those on steroid drugs. Weight bearing exercise on a regular basis is one of the best ways in which you can keep your muscle tone, prevent bone loss and improve the quality of your life. Don't wait until the next new year to make this resolution!



Blood. 2003 Nov 20

Bone loss following hematopoietic stem cell transplantation: a long-term follow-up.

Schulte CM, Beelen DW.

Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany.

Transplantation-associated bone loss is a well-known phenomenon, however effects of haematopoietic stem cell transplantation are insufficiently characterized. We conducted a prospective, unicentric long-term follow-up in 280 patients undergoing allogeneic HSCT. Bone mineral density was measured before transplantation and then yearly for at least 4 years. Patients received vitamin D plus calcium until steroid withdrawal. Mean baseline BMD was normal. We demonstrated significant bone loss with nadir BMD at month 6 for the spine and at month 24 for total body and femoral neck. Average annual bone loss was 0.6 % for spine, 0.4 % for total body, 2.3 % for femoral neck and 3.5% for Wards triangle. While spine and total body BMD returned to baseline, bone loss at femoral neck sites was attenuated, but BMD did not return to baseline until month 48 (p< 0.0001 for femoral neck and Wards triangle). Univariate factor analysis of 15 potential risk factors for rapid bone loss revealed a positive correlation of bone loss with steroid and cyclosporine A use, baseline BMD and loss of muscle mass (overwhelming power of steroid use in multifactor analysis). Such rapid BMD changes probably increase fracture risk consecutive to irreversible microarchitectural changes even if osteodensitometry shows long-term recovery.

PMID: 14630805

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