Supporting Bone Health in Patients Receiving Stem Cell Transplant

New guidelines from the International Osteoporosis Foundation (IOF) address management of osteoporosis, fracture risk, and overall bone health among patients receiving autologous hematopoietic cell transplantation (AHCT).

AHCT is a common therapy for patients with hematologic malignancies, including multiple myeloma.

“Unfortunately, too many AHCT recipients are not being monitored and treated for bone fragility, despite the fact that poor bone health is a significant comorbidity post-AHCT,” said Nicholas Harvey, PhD, Chair of the IOF Committee of Scientific Advisors, via a press release. “We therefore urge all physicians who care for AHCT recipients to take action to protect their patients’ long-term bone health. It is important to keep in mind that fragility fractures can be severely debilitating, with resulting loss of physical independence and quality of life.”

The IOF guidelines recommend increased monitoring of bone fragility among this patient population, and administration of osteoporosis treatments for patients that are identified to be at high risk of bone loss or fracture. Post-transplant dual energy X-ray absorptiometry is encouraged to assess bone mineral density to determine patient risk. Other recommendations include lifestyle changes to promote bone health, such as a diet with adequate amounts of calcium, protein, and Vitamin D; a muscle-strengthening exercise regimen; and avoidance of tobacco and alcohol.

“This concise summary aims to encourage and assist hematologists and oncologists in addressing osteoporosis and fracture prevention in their AHCT patients,” said René Rizzoli, MD, PhD, Chair of the IOF Cancer and Bone Working Group. “The ‘check list’ includes bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures, with appropriate application of osteoporosis pharmacotherapies in those who are found to be at increased high risk of fracture.”

These guidelines were published in the Journal of Bone Oncology.