An individualised risk-adapted protocol of pre- and post transplant zoledronic acid reduces bone loss after allogeneic stem cell transplantation: results of a phase II prospective trial

Bone Marrow Transplant. 2017 Sep;52(9):1288-1293. doi: 10.1038/bmt.2017.108. Epub 2017 Jun 19.


Bone loss occurs frequently following allogeneic haematopoietic stem cell transplantation (alloSCT). The Australasian Leukaemia and Lymphoma Group conducted a prospective phase II study of pretransplant zoledronic acid (ZA) and individualised post-transplant ZA to prevent bone loss in alloSCT recipients. Patients received ZA 4 mg before conditioning. Administration of post-transplant ZA from days 100 to 365 post alloSCT was determined by a risk-adapted algorithm based on serial bone density assessments and glucocorticoid exposure. Of 82 patients enrolled, 70 were alive and without relapse at day 100. A single pretransplant dose of ZA prevented femoral neck bone loss at day 100 compared with baseline (mean change -2.6±4.6%). Using the risk-adapted protocol, 42 patients received ZA between days 100 and 365 post alloSCT, and this minimised bone loss at day 365 compared with pretransplant levels (mean change -2.9±5.3%). Femoral neck bone loss was significantly reduced in ZA-treated patients compared with historical untreated controls at days 100 and 365. This study demonstrates that a single dose of ZA pre-alloSCT prevents femoral neck bone loss at day 100 post alloSCT, and that a risk-adapted algorithm is able to guide ZA administration from days 100 to 365 post transplant and minimise further bone loss.

Publication types

  • Clinical Trial, Phase II
  • Multicenter Study

MeSH terms

  • Bone Density / physiology*
  • Diphosphonates / pharmacology
  • Diphosphonates / therapeutic use*
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Hematopoietic Stem Cell Transplantation / methods
  • Humans
  • Imidazoles / pharmacology
  • Imidazoles / therapeutic use*
  • Male
  • Middle Aged
  • Prospective Studies
  • Transplantation Conditioning / adverse effects*
  • Transplantation Conditioning / methods
  • Transplantation, Homologous / adverse effects*
  • Transplantation, Homologous / methods
  • Zoledronic Acid


  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid