ICCBH2017 Poster Presentations (1) (209 abstracts)
Growth, bone and muscle mass are adversely affected in bone marrow transplant recipients: a body composition analysis
Artemis Doulgeraki 1 , E Vlachopapadopoulou 2 , I Peristeri 3 , A Paisiou 3 , G Polizois 1 , K Kaisari 3 , I Monopolis 4 , G Vessalas 3 , S Michalacos 2 & V Kitra 3
1Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece; 2Department of Endocrinology, Growth and Development, “P.&A. Kyriakou” Children’s Hospital, Athens, Greece; 3Bone Marrow Transplant Unit, Oncology Unit M. V. Vardinogianni “ELPIDA”, “Agia Sophia” Children’s Hospital, Athens, Greece; 4Biostatistician, Athens, Greece.
Objectives: There are many factors leading to poor bone health and imbalanced body composition in bone marrow transplant (BMT) recipients. We aimed to report our patients’ profile and to correlate it with clinical parameters.
Methods: Cross-sectional study of paediatric BMT patients. Assessment of growth (height, weight, BMI) and dual-energy X-ray absorptiometry (DXA) for evaluation of bone mineral density (BMD) and geometry, muscle and fat mass. All results were converted to Z-scores. Also, lean tissue mass and fat mass indexes were calculated (LTMI and FMI, respectively) and BMD was corrected for height, where indicated. Comparisons were made with 57 Greek controls and between patient subgroups.
Results: 34 patients, aged 14.6±3 years were studied (of which 15 girls, 27 adolescents and 12 with a previous diagnosis of acute lymphoblastic leukaemia). Six patients (17%) sustained a total of 12 fractures (1 vertebral) and three had osteonecrosis. 85% were on vitamin D and calcium supplements and 41% were exercising regularly. 35% were on hormone replacement therapy for hypogonadism and 23% had low vitamin D. Compared to controls, our population had impaired growth, lower lumbar BMD Z-score (mean: −0.5±1.3, P<0.01) lighter and smaller bones, with lower strength and less muscle mass (LTMI Z-score: −1.7±1.3, P<0.01). Within-group analysis revealed that female sex, prepubertal status, hypogonadism and lack of regular exercise adversely affected both total body (less head) BMD and LTMI. History of graft-versus host disease led to lower Z-score for bone strength (bone mineral content/lean tissue mass ratio), mean value 0.2±1.1, P=0.03). Of note, BMD and body composition were not affected by inadequate calcium intake, history of bone pain, radiotherapy or corticosteroid treatment (P>0.05). Finally, strong and positive correlations were found between BMI, bone width and BMD at both sites of measurement, LTMI and FMI (P<0.01).
Conclusions: In our cohort, and despite proper dietary supplementation and hypogonadism treatment, growth, bone and muscle mass were adversely affected, whereas fat mass was comparable to controls. Optimizing BMI through lifestyle interventions and enhancing bone width through mechanical loading, may prove to be useful clinical targets, in order to improve body composition profile in these patients.
Disclosure: The authors declared no competing interests.
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