Poster Presentation ESA-SRB-APEG-NZSE 2022

Trabecular Bone Score declines significantly post allogeneic bone marrow transplant independent of DXA T-score (#287)

Joanna Y Gong 1 , Cherie Chiang 2 , Minh VH Le 1 , Lydia F Limbri 3 , Spiros Fourlanos 1 , Christopher J Yates 4
  1. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
  2. Department of Diabetes & Endocrinology, Department of Chemical Pathology, Royal Melbourne Hospital, Parkville, Victoria, 3050
  3. University of Melbourne, Parkville, Victoria, 3052
  4. Department of Diabetes & Endocrinology, Royal Melbourne Hospital, and Department of Medicine, University of Melbourne, Parkville, Victoria, 3050

Background: As outcomes from allogeneic bone marrow transplantation (BMT) improve, monitoring for longer-term complications becomes increasingly important. Decline in bone health post BMT is well-established, although the pathophysiology may be unique1. Trabecular bone score (TBS) is opportunistically acquired during DXA scans, assesses vertebral micro-architecture and has established utility in fracture risk prediction. As glucocorticoid use in BMT subjects is known to cause vertebral fragility, TBS may be a useful adjunct to triage patients for anti-resorptive treatment.

Aims: To compare the change in bone mineral density (BMD) and TBS in patients pre and post BMT.

Methods: All patients who underwent BMT and had a DXA scan performed between 2019 and 2021 at the Royal Melbourne Hospital, including a pre BMT and post BMT DXA were included. Patient characteristics and DXA values were collected from the electronic medical record and TBS iNsight was used to calculate TBS. 

Results: 207 patients were identified, of which 50 had scans pre and post BMT. 35 of these 50 patients (70%) were male and the mean BMI was 27.3 ± 5.29kg/m2. 26 (52%) had related donors, 8 (16%) underwent total body irradiation and 33 (66%) had graft versus host disease. There were statistically significant decreases in T-scores and TBS post BMT (Figure 1), with no significant correlation between relative declines in T-score and TBS (Table 1). Separately evaluating the 82 DXA scans performed post BMT, there was a non-statistically significant increase in FRAX 10-year fracture risk when the calculation was adjusted for TBS (Figure 2).

Conclusions: Bone density and TBS decline significantly post transplantation. TBS provides a distinct, complementary method for assessing fracture risk post BMT and should be considered in this population to triage patients for anti-resorptive therapy.

 

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  1. Lim Y, Baek KH, Kim HJ, Lee S, Lee JW, Kang MI. Changes in trabecular bone score and bone mineral density following allogeneic hematopoietic stem cell transplantation. Bone. 2019;124:40-6.