Risk factors for haematopoietic stem cell transplant (HSCT) associated bone loss: bone marrow transplantation associated bone loss

BONE MARROW TRANSPLANTATION (BMT) also called haematopoietic stem cell transplant (HSCT) is the treatment of choice for many haematological diseases including haematological malignancies and different types of anaemia. The number of HSCT is increasing annually, mainly because advanced research that has been conducted in this area has exponentially increased its number of indications and has significantly improved transplantation techniques and supportive care practices. These improvements collectively have led to an increase in the overall survival of HSCT patients. However, as post-HSCT survival is increasing, there is an improved awareness regarding late complications of HSCT. Unpredictable bone loss is one of the major post-HSCT complications that can cause significant morbidity and impair the quality of life of a survivor. Although the exact mechanism of post-HSCT bone loss is not yet known but previous studies have suggested numerous factors like destructive preparative regimen (high dose chemotherapy, total body irradiation); treatment-related complications such as graft-versus-host disease (GVHD), endocrine abnormalities (diabetes mellitus, thyroid dysfunction, adrenal insufficiency), lack of physical activity and the underlying disease itself are responsible for HSCT associated bone loss. Enough data has been collected that suggests that post-HSCT bone loss should be prevented and treated using the same preventive and treatment modalities as used for the general population. Various guidelines (EBMT, CIBMTR, and ASBMT) have also been formed that helps in keeping a check on patients deteriorating bone health.