Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.
Bone Marrow Transplant. 2011 Jan;46(1):1-9. doi: 10.1038/bmt.2010.198. Epub 2010 Aug 23.
Long-term survivors of hematopoietic cell transplantation (HCT) are at risk for loss of bone mineral density (BMD) and subsequent osteoporosis. There is a lack of clear guidelines for the screening, prevention and treatment of bone loss after HCT. We reviewed the prevailing literature and provide guidelines developed by our center for the screening and management of this complication. Bone loss occurs predominantly within the first 6-12 months after autologous and allogeneic HCT. Recovery first occurs in the lumbar spine and is followed by a slower recovery of BMD in the femoral neck. BMD may not return to baseline levels in patients with continuing exposure to corticosteroids and calcineurin inhibitors. All HCT recipients should be advised general interventions to reduce fracture risk including adequate intake of calcium and vitamin D. We recommend screening all adult allogeneic and autologous HCT recipients with dual-energy X-ray absorptiometry 1 year after transplantation. Patients at high risk for bone loss (for example, patients receiving ≥ 5 mg of prednisone equivalent daily for > 3 months) can be screened earlier (for example, 3-6 months after HCT). Where indicated, bisphosphonates or other anti-resorptive agents (for example, calcitonin) can be used for prevention or treatment of osteoporosis in adult HCT recipients. Pediatric HCT recipients should be referred to a pediatric endocrinologist for evaluation and treatment of bone loss. There remain several areas of uncertainty that need further research in adult and pediatric HCT recipients, such as the optimal timing and frequency of screening for loss of bone mineral density, relationship of bone loss with risk of fractures, selection of appropriate patients for pharmacologic therapy, and optimal dosing schedule and duration of therapy with anti-resorptive agents.
造血细胞移植（HCT）后的长期幸存者有发生骨密度（BMD）丢失和随后发生骨质疏松症的风险。目前缺乏针对 HCT 后骨丢失筛查、预防和治疗的明确指南。我们回顾了现有文献，并提供了我们中心制定的用于筛查和管理这种并发症的指南。BMD 丢失主要发生在自体和异基因 HCT 后的前 6-12 个月内。首先在腰椎恢复，随后股骨颈的 BMD 恢复较慢。持续接触皮质类固醇和钙调神经磷酸酶抑制剂的患者，BMD 可能无法恢复到基线水平。应建议所有 HCT 受者采取一般干预措施来降低骨折风险，包括摄入足够的钙和维生素 D。我们建议在移植后 1 年对所有成人异基因和自体 HCT 受者进行双能 X 线吸收法筛查。有骨丢失高风险的患者（例如，每天接受 ≥ 5mg 泼尼松当量治疗超过 3 个月的患者）可提前（例如，HCT 后 3-6 个月）进行筛查。在有指征的情况下，可使用双膦酸盐或其他抗吸收剂（例如，降钙素）预防或治疗成人 HCT 受者的骨质疏松症。应将儿科 HCT 受者转介给儿科内分泌医生以评估和治疗骨丢失。在成人和儿科 HCT 受者中，仍有几个存在不确定性的领域需要进一步研究，例如骨密度丢失的最佳筛查时机和频率、骨丢失与骨折风险的关系、选择合适的患者进行药物治疗、以及抗吸收剂的最佳剂量方案和治疗持续时间。
