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Zoledronic acid prevents bone loss after allogeneic haemopoietic stem cell transplantation

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Allogeneic haemopoietic stem cell transplant (alloHSCT) patients are at increased risk of osteoporosis. Zoledronic acid (ZA) is a potent i.v. bisphosphonate; however, there are few data on ZA use after alloHSCT. The aim of this study is to examine the effect of a single 4 mg ZA infusion in alloHSCT patients with either osteoporosis (T‐score < −2.5) or rapid bone loss post‐alloHSCT. An uncontrolled, prospective study of 12 consecutive patients receiving ZA, predominantly within the first year post‐HSCT. Bone mineral density (BMD) was measured by dual‐energy X‐ray absorptiometry at the spine and proximal femur pretransplant, pre‐ZA and post‐ZA. The median annualized percentage change in total hip BMD between the pretransplant scan and the scan immediately before ZA was −13% (range, −51 to +3.6%). After ZA treatment, the total hip BMD increased by a median of +3.3% (range, −20.4 to +14.8%) in 75% of patients. The median annualized percentage change in femoral neck BMD between the pretransplant scan and the scan immediately before ZA was −13.2% (range, −40 to +1.0%). Post‐ZA, femoral neck BMD increased by a median of +1.4% (range, −22.2 to +33.6%). Only one patient continued to lose bone from the femoral neck post‐ZA infusion. The median annualized percentage change in spinal BMD pretransplant was −12.5% (range, −38 to +6.9%). Post‐ZA, spinal BMD decreased by a median of −2.8% (range, −27.6 to +24.4%). Four patients continued to lose bone from the spine post‐ZA. ZA reduces bone loss in most patients after alloHSCT. Our data require confirmation in a larger prospective, randomized study.
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Keywords: allogeneic stem cell transplant; bone loss; osteoporosis; zoledronic acid

Document Type: Research Article

Affiliations: Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia

Publication date: 01 September 2006

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