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Bone management in hematologic stem cell transplant recipients

Osteoporosis International volume 29, pages 2597–2610 (2018)Cite this article

Abstract

Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for patients with some malignant and non-malignant hematological diseases. Advances in transplantation techniques and supportive care measures have substantially increased the number of long-term HSCT survivors. This has led to an increasing patient population suffering from the late effects of HSCT, of which, bone loss and its consequent fragility fractures lead to substantial morbidity. Altered bone health, with consequent fragility fractures, and chronic graft-versus-host disease (GVHD) are factors affecting long-term quality of life after HSCT. Hypogonadism, HSCT preparative regimens, nutritional factors, and glucocorticoids all contribute to accelerated bone loss and increased fracture risk. Management strategies should include bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures. Evidence has accumulated permitting recommendations for more attentiveness to evaluation and monitoring of bone health, with appropriate application of osteoporosis pharmacotherapies to patients at increased risk of bone loss and fracture.

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, University of British Columbia, 150 – 943 W. Broadway, Vancouver, V5Z 4E1, Canada

    D. L. Kendler

  2. CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    J. J. Body

  3. Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy

    M. L. Brandi

  4. Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, Canada

    R. Broady

  5. Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain

    J. Cannata-Andia

  6. Haematology Department, IIS Princesa, Hospital de la Princesa, Madrid, Spain

    M. J. Cannata-Ortiz

  7. Rheumatology Department, Military Hospital Mohammed V, Mohammed V-Souissi University, Rabat, Morocco

    A. El Maghraoui

  8. Department of Radiology, University of Foggia, Foggia, Italy

    G. Guglielmi

  9. Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nord West Hospital, Frankfurt, Germany

    P. Hadji

  10. International Osteoporosis Foundation (IOF), Nyon, Switzerland

    D. D. Pierroz

  11. Department of Gynaecology, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa

    T. J. de Villiers

  12. Mediclinic Panorama, Cape Town, South Africa

    T. J. de Villiers

  13. Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland

    R. Rizzoli

  14. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia

    P. R. Ebeling

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  1. D. L. Kendler
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  2. J. J. Body
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  7. A. El Maghraoui
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  8. G. Guglielmi
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  9. P. Hadji
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  11. T. J. de Villiers
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  13. P. R. Ebeling
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Consortia

for the International Osteoporosis Foundation Committee of Scientific Advisors Working Group on Cancer and Bone Disease

Corresponding author

Correspondence to D. L. Kendler.

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Conflicts of interest

P Hadji received honoraria, travel grants, and scientific research grants from Amgen, Eli Lilly, MSD, Novartis, Pfizer, Procter & Gamble, and Roche. D Kendler received honoraria, speakers bureau, and/or research grants from Amgen, Eli Lilly, MSD, Pfizer, Astrazenica, and Astellas. T de Villiers has acted as a consultant or speaker for the following companies: Abbott, Amgen, Aspen, MSD, Pfizer. R Rizzoli received fees for consultancy or lectures from Danone, EffRx, Nestlé, ObsEva, and Radius Health. PR Ebeling received research grants, honoraria, and/or speakers’ fees from Amgen, Eli Lilly, Novartis, and Gilead. J Cannata-Andia received honoraria and scientific research grants from Amgen, Shire, and VIFOR/Fresenius. JJ Body, ML Brandi, MJ Cannata-Ortiz, A El Magrahoui, G Guglielmi, and DD Pierroz have no conflict of interest to declare.

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Kendler, D., Body, J., Brandi, M. et al. Bone management in hematologic stem cell transplant recipients. Osteoporos Int 29, 2597–2610 (2018). https://doi.org/10.1007/s00198-018-4669-4

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Keywords

  • Bone loss
  • Bone marrow
  • Bone mineral density
  • Fracture
  • Hematopoietic stem cell
  • Transplantation