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Updated: Apr 13, 2026
In Vivo Osteo-organoid Approach for Harvesting Therapeutic Hematopoietic Stem/Progenitor Cells
Published on: February 16, 2024
Changes in bone mineral density and bone turnover markers in patients undergoing hematopoietic stem cell transplant
Aditi Pandit1, M K Garg1, N Kotwal2
1Commandant, Military Hospital, Shillong, Meghalaya,, India.
Insights
Hematopoietic stem cell transplant (HSCT) causes significant bone loss, particularly at the hip, within 6 months. Bone mineral density improves by 12 months, except at Ward's triangle, indicating multifactorial causes.
Area of Science:
- Endocrinology
- Orthopedics
- Hematology
Background:
- Hematopoietic stem cell transplant (HSCT) is associated with endocrine complications and bone mass reduction.
- Evaluating post-HSCT bone loss is crucial for patient management.
Purpose of the Study:
- To prospectively assess bone loss and recovery following HSCT.
- To identify factors influencing bone mineral density changes post-transplant.
Main Methods:
- Prospective study of 25 HSCT patients (17 males, 8 females).
- Bone mineral density (BMD) and bone markers measured at baseline, 3-6 months, and 12 months.
- Analysis included patient age, graft type (allogeneic/autologous), and steroid use.
Main Results:
- Significant BMD decline observed at total femur, femoral neck, trochanter, and Ward's triangle at 6 months post-HSCT.
- BMD recovered by 12 months except at Ward's triangle; whole body and lumbar spine BMD remained stable.
- Younger patients, allogeneic grafts, and steroid use correlated with greater hip bone loss.
Conclusions:
- Significant bone loss occurs 6 months post-HSCT, primarily affecting cortical bone.
- Bone mass recovers by 12 months, with persistent loss at Ward's triangle.
- Post-HSCT bone loss is multifactorial, influenced by patient characteristics and treatment.
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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