Adverse Fat Depots and Marrow Adiposity Are Associated With Skeletal Deficits and Insulin Resistance in Long-Term Survivors of Pediatric Hematopoietic Stem Cell Transplantation.

TitleAdverse Fat Depots and Marrow Adiposity Are Associated With Skeletal Deficits and Insulin Resistance in Long-Term Survivors of Pediatric Hematopoietic Stem Cell Transplantation.
Publication TypeJournal Article
Year of Publication2015
AuthorsMostoufi-Moab S, Magland J, Isaacoff EJ, Sun W, Rajapakse CS, Zemel BS, Wehrli F, Shekdar K, Baker JF, Long J, Leonard MB
JournalJ Bone Miner Res
Date Published2015 Sep
KeywordsAdipocytes, Adiposity, Adolescent, Adult, Anthropometry, Blood Pressure, Body Mass Index, Bone and Bones, Bone Marrow, Case-Control Studies, Child, Cross-Sectional Studies, Female, Follow-Up Studies, Hematologic Neoplasms, Hematopoietic Stem Cell Transplantation, Humans, Insulin Resistance, Intra-Abdominal Fat, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Male, Osteoblasts, Radiography, Spinal Fractures, Survivors, Tibia, Young Adult

Allogeneic hematopoietic stem-cell transplantation (alloHSCT) survivors treated with total body irradiation (TBI) exhibit bone deficits and excess adiposity, potentially related to altered mesenchymal stem cell differentiation into osteoblasts or adipocytes. We examined associations among fat distribution, bone microarchitecture, and insulin resistance in alloHSCT survivors after TBI. This was a cross-sectional observational study of 25 alloHSCT survivors (aged 12 to 25 years) a median of 9.7 (4.3 to 19.3) years after alloHSCT compared to 25 age-, race-, and sex-matched healthy controls. Vertebral MR spectroscopic imaging and tibia micro-MRI were used to quantify marrow adipose tissue (MAT) and trabecular microarchitecture. Additional measures included DXA whole-body fat mass (WB-FM), leg lean mass (Leg-LM), trunk visceral adipose tissue (VAT), and CT calf muscle density. Insulin resistance in alloHSCT survivors was estimated by HOMA-IR. AlloHSCT survivors had lower Leg-LM (p < 0.001) and greater VAT (p < 0.01), MAT (p < 0.001), and fat infiltration of muscle (p = 0.04) independent of WB-FM, versus matched controls; BMI did not differ. Survivors had lower bone volume fraction and abnormal microarchitecture including greater erosion and more rod-like structure versus controls (all p = 0.04); 14 had vertebral deformities and two had compression fractures. Greater WB-FM, VAT, MAT, and muscle fat infiltration were associated with abnormal trabecular microarchitecture (p < 0.04 for all). AlloHSCT HOMA-IR was elevated, associated with younger age at transplantation (p < 0.01), and positively correlated with WB-FM and VAT (both p < 0.01). In conclusion, the markedly increased marrow adiposity, abnormal bone microarchitecture, and abnormal fat distribution highlight the risks of long-term treatment-related morbidity and mortality in alloHSCT recipients after TBI. Trabecular deterioration was associated with marrow and visceral adiposity. Furthermore, long-term survivors demonstrated sarcopenic obesity, insulin resistance, and vertebral deformities. Future studies are needed to identify strategies to prevent and treat metabolic and skeletal complications in this growing population of childhood alloHSCT survivors.

Alternate JournalJ. Bone Miner. Res.
PubMed ID25801428
PubMed Central IDPMC4540662
Grant ListUL1 TR000003 / TR / NCATS NIH HHS / United States
T32 CA009679 / CA / NCI NIH HHS / United States
UL1TR000003 / TR / NCATS NIH HHS / United States
UL1-RR-024134 / RR / NCRR NIH HHS / United States
K07 CA166177 / CA / NCI NIH HHS / United States
K24 DK076808 / DK / NIDDK NIH HHS / United States
UL1 RR024134 / RR / NCRR NIH HHS / United States