Bone Density and Trabecular Bone Score Decline Rapidly in the First Year After Bone Marrow Transplantation with a Marked Increase in 10-Year Fracture Risk

Gong, JY; Chiang, C; Wark, JD; Ritchie, D; Panek-Hudson, Y; Le, MV; Limbri, L; Fabila, N; Fourlanos, S; Yates, CJ

Author(s): Gong, JY; Chiang, C; Wark, JD; Ritchie, D; Panek-Hudson, Y; Le, MV; Limbri, L; Fabila, N; Fourlanos, S; Yates, CJ;
Details: Publication Year 2024-04,Volume 114,Issue #4,Page 377-385
Journal Title: Calcified Tissue International
Publication Type: Research article
Abstract: As outcomes from allogeneic bone marrow transplantation (BMT) have improved, prevention of long-term complications, such as fragility fractures, has gained importance. We aimed to assess areal bone mineral density (aBMD) and trabecular bone score (TBS) changes post BMT, and determine their relationship with fracture prevalence. Patients who attended the Royal Melbourne Hospital (RMH) BMT clinic between 2005-2021 were included. Patient characteristics and dual-energy X-ray absorptiometry (DXA) values were collected from the electronic medical record and a survey. TBS iNsight™ was used to calculate TBS for DXA scans performed from 2019 onwards. 337 patients with sequential DXAs were eligible for inclusion. Patients were primarily male (60%) and mean age ± SD was 45.7 ± 13.4 years. The annualised decline in aBMD was greater at the femoral neck (0.066g/cm(2) (0.0038-0.17)) and total hip (0.094g/cm(2) (0.013-0.19)), compared to the lumbar spine (0.049g/cm(2) (- 0.0032-0.16)), p < 0.0001. TBS declined independently of aBMD T-scores at all sites. Eighteen patients (5.3%) sustained 19 fractures over 3884 person-years of follow-up post-transplant (median follow-up 11 years (8.2-15)). This 5.3% fracture prevalence over the median 11-year follow-up period is higher than what would be predicted with FRAX® estimates. Twenty-two patients (6.5%) received antiresorptive therapy, and 9 of 18 (50%) who fractured received or were on antiresorptive therapy. In BMT patients, aBMD and TBS decline rapidly and independently in the first year post BMT. However, FRAX® fracture probability estimates incorporating these values significantly underestimate fracture rates, and antiresorptive treatment rates remain relatively low.
Publisher: Springer Nature
Keywords: Humans; Male; *Bone Density; *Osteoporotic Fractures/epidemiology; Cancellous Bone; Bone Marrow Transplantation/adverse effects; Absorptiometry, Photon; Lumbar Vertebrae; Femur Neck; Risk Assessment; Bone density; Fracture; Osteoporosis; Post-transplant care; Trabecular bone score
Department(s): Clinical Haematology
Publisher's Version: https://doi.org/10.1007/s00223-024-01189-1
Open Access at Publisher's Site: https://doi.org/10.1007/s00223-024-01189-1
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-04-02 04:13:38

Last Modified: 2024-04-02 04:13:52