Faulhaber G A M, Premaor M O, Moser Filho H L, Silla L M, Furlanetto T W
Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Bone Marrow Transplant. 2009 Jun;43(12):953-7. doi: 10.1038/bmt.2009.70. Epub 2009 Apr 13.
Post-BMT subjects have an increased bone fracture risk. Additionally, several factors were associated with osteopenia and osteoporosis in these individuals. We aimed to identify other factors associated with osteopenia and osteoporosis in allogeneic post-BMT subjects. We conducted a cross-sectional study with 47 allogeneic post- BMT subjects. Serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, ferritin, vitamin B(12), insulin, glucose, cholesterol and triglyceride levels were measured. Insulin resistance and secretion were estimated through the homeostatic model assessment for insulin resistance (HOMA-IR) and homeostatic model assessment for beta-cell function (HOMA-B), respectively. A bone densitometry (BMD) was also obtained. The median time after BMT was 47.7 (12-115) months. Osteoporosis was identified in 17.0% of the subjects and osteopenia in 19.7%. The mean serum ferritin (P=0.002), insulin (P<0.0001), glucose (P=0.003) and triglyceride (P=0.018) levels were higher in individuals with osteopenia/osteoporosis. HOMA-IR (P<0.0001) and HOMA-B (P<0.0001) were increased in post-BMT subjects with osteopenia/osteoporosis. There was no other factor associated with the outcome. After adjustments ferritin, serum 25(OH)D and HOMA-IR remained independently associated with osteopenia/osteoporosis; however triglycerides no longer were. In conclusion, in the present study, low serum 25(OH)D levels, high serum ferritin levels and insulin resistance were associated with osteopenia/osteoporosis in post-BMT subjects.
异基因造血干细胞移植（BMT）后的受试者骨折风险增加。此外，这些个体中的几个因素与骨质减少和骨质疏松症有关。我们旨在确定异基因BMT后受试者中与骨质减少和骨质疏松症相关的其他因素。我们对47名异基因BMT后受试者进行了一项横断面研究。测量了血清25-羟基维生素D（25(OH)D）、甲状旁腺激素、铁蛋白、维生素B12、胰岛素、葡萄糖、胆固醇和甘油三酯水平。分别通过胰岛素抵抗稳态模型评估（HOMA-IR）和β细胞功能稳态模型评估（HOMA-B）来估计胰岛素抵抗和分泌。还进行了骨密度测定（BMD）。BMT后的中位时间为47.7（12 - 115）个月。17.0%的受试者被诊断为骨质疏松症，19.7%的受试者被诊断为骨质减少。骨质减少/骨质疏松症患者的平均血清铁蛋白（P = 0.002）、胰岛素（P < 0.0001）、葡萄糖（P = 0.003）和甘油三酯（P = 0.018）水平较高。BMT后患有骨质减少/骨质疏松症的受试者中HOMA-IR（P < 0.0001）和HOMA-B（P < 0.0001）升高。没有其他因素与该结果相关。调整后，铁蛋白、血清25(OH)D和HOMA-IR仍然与骨质减少/骨质疏松症独立相关；然而，甘油三酯不再相关。总之，在本研究中，血清25(OH)D水平低、血清铁蛋白水平高和胰岛素抵抗与BMT后受试者的骨质减少/骨质疏松症有关。
