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Bone management in hematologic stem cell transplant recipients.

D L Kendler1, J J Body2, M L Brandi3

  • 1Department of Medicine, Division of Endocrinology, University of British Columbia, 150 - 943 W. Broadway, Vancouver, V5Z 4E1, Canada. davidkendler@gmail.com.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|September 5, 2018
PubMed
Summary

Hematopoietic stem cell transplantation (HSCT) survivors face significant bone loss and fracture risks due to factors like GVHD and treatment side effects. Early monitoring and interventions are crucial for managing bone health and improving long-term quality of life.

Keywords:
Bone lossBone marrowBone mineral densityFractureHematopoietic stem cellTransplantation

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Area of Science:

  • Hematology
  • Oncology
  • Bone Metabolism

Background:

  • Hematopoietic stem cell transplantation (HSCT) offers curative potential for hematological malignancies and non-malignant disorders.
  • Increased survival rates post-HSCT have highlighted the emergence of long-term complications, including significant bone health issues.
  • Altered bone health and fragility fractures represent a major source of morbidity impacting the quality of life for HSCT survivors.

Purpose of the Study:

  • To review the contributing factors to bone loss in HSCT survivors.
  • To outline current management strategies for bone health in this patient population.
  • To emphasize the need for proactive bone health monitoring and intervention.

Main Methods:

  • Literature review of studies focusing on bone metabolism after HSCT.
  • Analysis of factors contributing to bone loss, including hypogonadism, preparative regimens, nutrition, and glucocorticoid use.
  • Evaluation of current recommendations for bone mineral density assessment and fracture risk stratification.

Main Results:

  • Accelerated bone loss and increased fracture risk are common late effects of HSCT.
  • Key contributors to bone loss include hypogonadism, conditioning regimens, nutritional deficiencies, and corticosteroid therapy.
  • Chronic graft-versus-host disease (GVHD) also negatively impacts bone health.
  • Current management involves bone mineral density screening, risk factor assessment, lifestyle modifications, and pharmacotherapy.

Conclusions:

  • Bone loss and fracture risk are significant concerns for long-term HSCT survivors.
  • A comprehensive approach involving regular monitoring and targeted interventions is essential.
  • Early and appropriate management of bone health can mitigate morbidity and improve quality of life.