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ORIGINAL ARTICLE
Year : 2015  |  Volume : 19  |  Issue : 3  |  Page : 393-398

Changes in bone mineral density and bone turnover markers in patients undergoing hematopoietic stem cell transplant


1 Commandant, Military Hospital, Shillong, Meghalaya, India
2 Department of Endocrinology, Army Hospital Research and Referral, New Delhi, India
3 Department of Hematology, Army Hospital Research and Referral, New Delhi, India

Correspondence Address:
M K Garg
Military Hospital, Shillong - 793 001, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.152785

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Introduction: 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. Materials and 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.


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