Background/Purpose: The main goal of our study was to evaluate the efficacy and safety of bisphosphonates and/or general preventive strategies in the prevention and treatment of post-transplant bone loss.

Methods: We conducted a comprehensive search in electronic databases until September 2014. We retrieved articles describing patients with bone loss or fractures who received hematopoietic stem cell transplantation (HSCT).  Study selection, data collection and quality assessment were independently performed by two pairs of investigators. Studies were included if they were controlled trials, with a follow-up period of at least 12 months. Our primary outcome was change in BMD. Secondary outcomes included fracture, and bone turnover markers levels. Meta-analyses were performed when there were two or more studies with similar outcomes.

Results: Eleven publications were included (8 studies randomized trials (12 publications) and 3 studies non-randomized trials with a control group (4 publications)).  565 participants underwent HSCT for hematological diseases or malignancies: 85.7% underwent allogeneic HSCT, 1.4% underwent autologous HSCT, and 12.9% did not report the type of HSCT.  Participant’s age varied from 15 to 70 years. Seven comparisons were evaluated: (i) Zolendronic acid + Calcium + Vitamin D versus Calcium + Vitamin D; (ii) Pamidronate + Calcium +Vitamin D + hormone replacement therapy (HRT) versus Calcium + Vitamin D + HRT; (iii) Risedronate + Calcium +Vitamin D versus Calcium + Vitamin D; (iv) Zolendronic acid + Calcium versus Calcium alone; (v) Calcium +Vitamin D +HRT versus Calcium + Vitamin D; (vi) Calcium + Calcitonin versus no intervention; (vii) Calcium alone versus no intervention. Percent change in BMD in lumbar spine was higher when comparing any bisphosphonate groups compared with non-bisphosphonate groups at 12-24 months (see Table). The risk of fractures or x-ray findings of subclinical vertebral fractures was not increased in any of the comparison groups during the study period. A greater reduction in various bone turnover and resorption marker levels was observed in the bisphosphonate groups compared to patients in the control groups at 1-12 months, including: bone alkaline phosphatase, urinary hydroxyproline excretion, serum type 1 procollagen amino-terminal propeptide, urinary- type 1 collagen amino-terminal telopeptide,  serum type 1 collagen cross-linked carboxy-terminal telopeptide beta, serum type 1 collagen carboxy-terminal telopeptide, and tartrate resistant acid phosphatase 5b. Flu-like symptoms were higher in Zolendronic acid treated patients.

Conclusion: Bisphosphonates are promising in the prevention and treatment of bone loss following HSCT. However bisphosphonates should be used with caution since they are not free of adverse effects.

(R), random-effects model; MD, mean difference; HRT, hormone replacement therapy

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevention-and-treatment-of-bone-loss-following-hematopoietic-stem-cell-transplantation-a-systematic-review-and-meta-analysis/