15. Post-Transplantation Bone Disease: Prevalence, Monitoring, Prevention, and Management Guidelines

  1. Bipin N Savani MD
  1. Kathryn Dahir,
  2. Brandon Perry and
  3. Shubhada Jagasia

Published Online: 6 SEP 2013

DOI: 10.1002/9781118473306.ch15

Blood and Marrow Transplantation Long-Term Management: Prevention and Complications

Blood and Marrow Transplantation Long-Term Management: Prevention and Complications

How to Cite

Dahir, K., Perry, B. and Jagasia, S. (2013) Post-Transplantation Bone Disease: Prevalence, Monitoring, Prevention, and Management Guidelines, in Blood and Marrow Transplantation Long-Term Management: Prevention and Complications (ed B. N. Savani), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118473306.ch15

Editor Information

  1. Professor of Medicine,Director, Long Term Transplant Clinic, Hematology and Stem Cell Transplantation Section, Vanderbilt University Medical Center, Nashville, TN, USA

Author Information

  1. Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

Publication History

  1. Published Online: 6 SEP 2013
  2. Published Print: 1 OCT 2013

ISBN Information

Print ISBN: 9781118473405

Online ISBN: 9781118473306

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Keywords:

  • osteoporosis;
  • osteonecrosis;
  • calcium;
  • vitamin D;
  • bisphosphonates;
  • glucocorticoids;
  • calcineurin inhibitors;
  • stem cell transplantation;
  • bone marrow transplantation

Summary

The increasing success of stem cell transplantation (SCT) has led to improved survival of patients and a higher awareness of long-term health consequences of this therapy. SCT deleteriously impacts bone health, correlating with increased risks of bone loss, vitamin D deficiency, and osteonecrosis. Each of these complications is discussed separately. Several factors contribute to SCT-related bone loss, the most significant of which is likely glucocorticoid exposure. Accelerated bone loss occurs within the first 6–12 months after transplantation, when immunosuppressive therapy is most intense. Vitamin D is vital for bone health, and deficiency is common among SCT recipients. Though vitamin D sufficiency alone does not prevent SCT-related bone loss, supplementation is safe, convenient, and has several potential health benefits. Osteonecrosis is a less common but potentially debilitating complication of SCT. A comprehensive strategy to protect bone health should encompass timely assessment of bone mineral density, minimization of glucocorticoid use, appropriate use of anti-osteoporosis medications, vitamin D supplementation, exercise, fall prevention, and avoidance of smoking and alcohol abuse.