Bone Loss in Allogeneic Transplant Patients.

Significant bone loss occurs in approximately half of patients undergoing allogeneic hematopoietic cell transplant [HCT] within the first 6-12 months. We are evaluating approaches to preventing and treating this loss. We track bone health in all HCT patients in a one year period. Bone health is evaluated by DEXA scans pre-HCT, 6 and 12 months post-transplant. Labs are also followed at the same time points: vitamin D, calcium, alk phos, TSH, osteocalcin CTX. The patients are placed on calcium and vitamin D supplementation according to levels pre-HCT. Depending on patients pre-HCT DEXA scores, those at high risk may receive a dose of zoledronic acid. HCT patients may receive these infusions at 6 and 12 months post-transplant depending on their DEXA scores. Patients who are osteopenic pre-HCT will also be referred to a bone health specialist. An up to date spreadsheet prompts us to check bone markers and DEXA scans pre-HCT and at day 180 and 360 milestones. Data collection is almost complete. Preliminary analysis indicates an improvement of vitamin D levels post-HCT and successfully identifying patients that may benefit from pre-HCT bisphosphate therapy, thereby improving the bone health of HCT patients. Patients benefit from earlier nurse practitioner managed interventions for bone health post-HCT. Further studies could help identify patients who would benefit from earlier interventions. We plan on integrating these findings with survivorship careplans and milestone visits. [ABSTRACT FROM AUTHOR]