J Korean Soc Endocrinol.  2000 Oct;15(4-5):561-570.

The Effect of Bone Marrow Transplantation on Bone Mineral Metabolism: 2 - Year Prospective Study

Affiliations
  • 1Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
  • 2Hemopoietic Stem Cell Transplantation Center, Seoul, Korea

Abstract

BACKGROUND
Loss of bone mass is usually detected after bone marrow transplantation (BMT), especially during the early post-transplant period. But little is known about the long-term effects of BMT on bone mineral metabolism.
METHODS
We have investigated prospectively 12 patients undergoing BMT (4 autologous, 8 allogeneic) for hematologic diseases (8 leukemia, 3 SAA, 1 MDS). Serum concentrations of calcium, phosphorus, creatinine, gonadotropins, sex hormones and bone turnover markers (osteocalcin and ICTP) were measured. The samples were collected before BMT and 1, 2, 3, 4, and 12 weeks, 6 months and 1, 2 years thereafter. Bone mineral density (BMD) was measured with DEXA (Dual Energy X-ray Absorptiometry) before BMT, 1 year and 2 year after BMT. In patients with amenorrbea, hormone replacement therapy was started from around 1 year after BMT
RESULTS
1. The mean bone loss in the lumbar spine, calculated as the percent change from the baseline to the level at 1 year and 2 year was 7.3% and 1.9%, respectively. The mean bone loss in the total proximal femur from the baseline to the level at 1 year and 2 year was 8.0% and 8.3% respectively. 2. The serum ICTP increased progressively until four weeks after BMT. Thereafter, it decreased gradually to reach basal values after one year and thereafter no more change until 2 year. Serum osteocalcin decreased progressively until three weeks after BMT. After that, it increased and reached basal values after 3 months. Osteocalcin increased at 6 month transiently but thereafter, it decreased to the level of slightly above basal value at 2 year. 3. Patients who were treated with TBI or pateints with GVHD had a tendency of lower BMD at l year and 2 year after BMT than those of patients without TBI or GVHD. 4. Eight out of nine women went into a menopausal state immediately after BMT and remained amenorrhea, evidenced by high gonadotropins and low estradiol levels. In contrast to women, gonadotropins and testosterone levels were not changed significantly in men after BMT.
CONCLUSION
The rapid impairment of bone formation and the increase in bone resorption, as shown by the biochemical markers in this study, might play a role in bone loss after BMT. The efficacy of HRT for the correction of hypogonadism and bone loss was evidenced by 2 year BMD which was much more increased compared to 1 year BMD, especially in vertebra.


MeSH Terms

Amenorrhea
Biomarkers
Bone Density
Bone Marrow Transplantation*
Bone Marrow*
Bone Resorption
Calcium
Creatinine
Estradiol
Female
Femur
Gonadal Steroid Hormones
Gonadotropins
Hematologic Diseases
Hormone Replacement Therapy
Humans
Hypogonadism
Leukemia
Male
Metabolism*
Osteocalcin
Osteogenesis
Phosphorus
Prospective Studies*
Spine
Testosterone
Calcium
Creatinine
Estradiol
Gonadal Steroid Hormones
Gonadotropins
Osteocalcin
Phosphorus
Testosterone
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