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Bone health in children and adolescents after allogeneic stem cell transplantation

High prevalence of vertebral compression fractures

  1. Mervi Taskinen MD1,†,*,
  2. Ulla M. Saarinen-Pihkala MD1,
  3. Liisa Hovi MD1,
  4. Kim Vettenranta MD1,
  5. Outi Mäkitie MD2

Article first published online: 4 JUN 2007

DOI: 10.1002/cncr.22796

Issue

Cancer

Cancer

Volume 110, Issue 2, pages 442–451, 15 July 2007

Additional Information

How to Cite

Taskinen, M., Saarinen-Pihkala, U. M., Hovi, L., Vettenranta, K. and Mäkitie, O. (2007), Bone health in children and adolescents after allogeneic stem cell transplantation. Cancer, 110: 442–451. doi: 10.1002/cncr.22796

Author Information

  1. 1

    Division of Hematology–Oncology and Stem Cell Transplantation, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

  2. 2

    Division of Endocrinology and Metabolism, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

  1. †

    Fax: (011) 358-9-47174707

*The Hospital for Children and Adolescents, University of Helsinki, P.O. Box 281, FIN-00029 Helsinki, Finland

Publication History

  1. Issue published online: 29 JUN 2007
  2. Article first published online: 4 JUN 2007
  3. Manuscript Accepted: 15 MAR 2007
  4. Manuscript Revised: 14 MAR 2007
  5. Manuscript Received: 24 JAN 2007

Funded by

  • Nona and Kullervo Väre Foundation
  • The Foundation for Pediatric Research
  • Päivikki and Sakari Sohlberg Foundation
  • Finnish Medical Society Duodecim
  • Research Funding of the Helsinki University Hospitals

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Keywords:

  • bone mineral density;
  • stem cell transplantation;
  • vertebral fracture;
  • childhood

After undergoing allogeneic stem cell transplantation in childhood, approximately one-third of young patients were found to have reduced bone mineral density (BMD) before reaching adulthood. This was due in part to inadequate BMD gain during the pubertal years. Instant vertebral assessment revealed a high prevalence of asymptomatic vertebral compression fractures in this group of patients.

Abstract

BACKGROUND

This cross-sectional study evaluated the overall bone health and the prevalence of vertebral complications after stem cell transplantation (SCT) in prepubertal children and adolescents.

METHODS

A total of 44 children and adolescents (median age, 10 years) were evaluated at a median of 3.8 years after SCT for areal bone mineral density (aBMD) with dual-energy X-ray absoptiometry and for vertebral fractures with instant vertebral assessment. Pretransplant and posttransplant medications and nutritional parameters were recorded, and plasma levels of vitamin D, calcium, phosphate, and parathormone were measured.

RESULTS

Of the 44 patients, 16 (36%) had a BMD Z-score of <−1.0. The patients with low BMD did not differ from the others with regard to their clinical or biochemical characteristics. Prepubertal patients had better BMD Z-scores at all sites compared with pubertal or postpubertal subjects. This was evident especially at the hip, in which the median aBMD Z-score in prepubertal patients (−0.2; range, −0.5 to +1.7) was found to be significantly higher than in pubertal (−1.1; range, −1.5 to +0.4) and postpubertal (−1.1; range, −2.6 to +0.5) patients (P = .03). Five patients (11%) had a history of peripheral fractures. Nine patients (20%) had vertebral compression fractures, which were asymptomatic in 7 patients.

CONCLUSIONS

Approximately one-third of patients who had undergone allogeneic SCT in childhood were found to have a reduced BMD before reaching adulthood. This was due in part to inadequate BMD gain during the pubertal years. The high prevalence of asymptomatic vertebral compression fractures calls for the systematic assessment of spinal health during the posttransplantation follow-up. Cancer 2007. © 2007 American Cancer Society.

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