A prospective study of bone loss and turnover after allogeneic bone marrow transplantation: effect of calcium supplementation with or without ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

1999-02-12

AUTHORS

MJ Välimäki, K Kinnunen, L Volin, R Tähtelä, E Löyttyniemi, K Laitinen, P Mäkelä, P Keto, T Ruutu

ABSTRACT

Transplantation of solid organs including heart, kidney, and liver is associated with rapid bone loss and increased rate of fracture; data on bone marrow transplantation recipients (BMT) are scarce. The purpose of the present study was to examine the magnitude, timing, and mechanism of bone loss following allogeneic BMT, and to study whether bone loss can be prevented by calcium with or without calcitonin. Sixty-nine patients undergoing allogeneic BMT for malignant blood diseases were enrolled into the study. Forty-four (22 women, 22 men) completed 6 months, and 36 patients 1 year follow-up. They were randomized to receive either no additional treatment (n = 22), or oral calcium 1 g twice daily for 12 months (n = 12) or the same dose of calcium plus intranasal calcitonin 400 IU/day for the first month and then 200 IU/day for 11 months (n = 10). Bone mineral density (BMD) at the lumbar spine and three femoral sites (femoral neck, trochanter, Ward’s triangle) was measured by dual-energy X-ray absorptiometry (DXA). Bone turnover rate was followed with markers of bone formation and resorption (serum bone-specific alkaline phosphatase (B-ALP), type I procollagen carboxyterminal (PICP) and aminoterminal propeptide (PINP), serum type I collagen carboxyterminal telopeptide (ICTP)). Serum testosterone was assayed in men. Calcium with or without calcitonin had no effect on bone loss or bone markers; consequently the three study groups were combined. During the first 6 post-transplant months BMD decreased by 5.7% in the lumbar spine and by 6.9% to 8.7% in the three femoral sites (P < 0.0001 for all); no significant further decline occured between 6 and 12 months. four out of 25 assessable patients experienced vertebral compression fractures. markers of bone formation reduced: b-alp by 20% at 3 weeks (P = 0.027), PICP by 40% (P < 0.0001) and pinp by 63% at 6 weeks (P < 0.0001), with a return to baseline by 6 months. the marker of bone resorption, serum ictp was above normal throughout the whole observation period, with a peak at 6 weeks (77% above baseline, P < 0.0001). in male patients serum testosterone decreased reaching a nadir (57% below baseline) at 6 weeks (P = 0.0003). In conclusion, significant bone loss occurs after BMT. It results from imbalance between reduced bone formation and increased bone resorption; hypogonadism may be a contributing factor in men. Bone loss can not be prevented by calcium with or without calcitonin. More... »

PAGES

355-361

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/sj.bmt.1701586

DOI

http://dx.doi.org/10.1038/sj.bmt.1701586

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1007706326

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/10100579


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100 period
101 post-transplant months BMD
102 present study
103 prospective study
104 purpose
105 rapid bone loss
106 rate
107 rate of fracture
108 ray absorptiometry
109 recipients
110 resorption
111 return
112 same dose
113 serum ICTP
114 serum testosterone
115 significant bone loss
116 significant further decline
117 sites
118 solid organs
119 spine
120 study
121 study group
122 supplementation
123 testosterone
124 timing
125 transplantation
126 transplantation recipients
127 treatment
128 turnover
129 turnover rate
130 vertebral compression fractures
131 weeks
132 whole observation period
133 years
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