As outcomes from allogeneic bone marrow transplantation (BMT) have improved, prevention of long-term complications, such as fragility fractures, has gained importance. We aimed to assess areal bone mineral density (aBMD) and trabecular bone score (TBS) changes post BMT, and determine their relationship with fracture prevalence. Patients who attended the Royal Melbourne Hospital (RMH) BMT clinic between 2005–2021 were included. Patient characteristics and dual-energy X-ray absorptiometry (DXA) values were collected from the electronic medical record and a survey. TBS iNsight™ was used to calculate TBS for DXA scans performed from 2019 onwards. 337 patients with sequential DXAs were eligible for inclusion. Patients were primarily male (60%) and mean age ± SD was 45.7 ± 13.4 years. The annualised decline in aBMD was greater at the femoral neck (0.066g/cm² (0.0038–0.17)) and total hip (0.094g/cm² (0.013–0.19)), compared to the lumbar spine (0.049g/cm² (− 0.0032–0.16)), p < 0.0001. TBS declined independently of aBMD T-scores at all sites. Eighteen patients (5.3%) sustained 19 fractures over 3884 person-years of follow-up post-transplant (median follow-up 11 years (8.2–15)). This 5.3% fracture prevalence over the median 11-year follow-up period is higher than what would be predicted with FRAX® estimates. Twenty-two patients (6.5%) received antiresorptive therapy, and 9 of 18 (50%) who fractured received or were on antiresorptive therapy. In BMT patients, aBMD and TBS decline rapidly and independently in the first year post BMT. However, FRAX® fracture probability estimates incorporating these values significantly underestimate fracture rates, and antiresorptive treatment rates remain relatively low.

随着同种异体骨髓移植（BMT）结果的改善，预防脆性骨折等长期并发症变得越来越重要。我们的目的是评估 BMT 后面积骨矿物质密度 (aBMD) 和骨小梁评分 (TBS) 的变化，并确定它们与骨折发生率的关系。2005 年至 2021 年间在皇家墨尔本医院 (RMH) BMT 诊所就诊的患者也被纳入其中。从电子病历和调查中收集患者特征和双能 X 射线吸收测定 (DXA) 值。TBS iNsight™ 用于计算 2019 年以来执行的 DXA 扫描的 TBS。337 名接受连续 DXA 治疗的患者符合纳入条件。患者主要为男性 (60%)，平均年龄 ± SD 为 45.7 ± 13.4 岁。与腰椎 (0.049g/cm 2 ) 相比，股骨颈 (0.066g/cm ² (0.0038–0.17)) 和全髋部 (0.094g/cm ^{2 (0.013–0.19 )} ) 的 aBMD 年化下降幅度更大(− 0.0032–0.16))，p  < 0.0001。所有站点的 TBS 下降与 aBMD T 分数无关。在移植后 3884 人年的随访中，18 名患者 (5.3%) 发生 19 处骨折（中位随访时间 11 年 (8.2-15)）。中位 11 年随访期内骨折发生率为 5.3%，高于 FRAX® 估计值的预测值。22 名患者 (6.5%) 接受了抗骨吸收治疗，18 名骨折患者中有 9 名 (50%) 接受或正在接受抗骨吸收治疗。在 BMT 患者中，aBMD 和 TBS 在 BMT 后的第一年迅速且独立地下降。然而，结合这些值的 FRAX® 骨折概率估计大大低估了骨折率，并且抗骨吸收治疗率仍然相对较低。