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Bone health after a transplant | CION Cancer Clinics
Bone loss is common after a bone marrow transplant, and it happens most quickly in the first months. Steroids, low hormones, low vitamin D and long rest in bed all play a part. It causes no pain until a bone breaks, so a bone density scan is how it is found. This page explains the causes, the scan, your T-score and what helps, and what only your transplant team can decide. At CION Cancer Clinics, our haematology team assesses whether a transplant or CAR-T fits your situation and coordinates care with qualified centres.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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The short answer
Why do bones thin after a transplant?
Bone loss after a bone marrow transplant is common, and it happens fastest in the first months. Steroids, low sex hormones, weeks of bed rest and some transplant medicines all take calcium out of the bones.
Why you may not feel it
Thinning bones cause no pain on their own. Many people find out only when a bone density scan is done, or when a bone breaks after a minor fall. That is why checks are arranged even when you feel well.
A different problem with a similar name
Some people develop avascular necrosis, where part of a bone, most often the hip, loses its blood supply. It is linked mainly to steroids. It usually shows as a deep ache in the groin, hip or knee that does not go away, and it needs an X-ray or MRI rather than a density scan.
Who is at higher risk
People who needed long or high courses of steroids for GVHD (graft-versus-host disease, where the donor cells attack your own tissues), women with early menopause, men with low testosterone, older adults and anyone who was very inactive for a long time.
Bone loss can be slowed and often partly reversed. Finding it early gives you the most options.What drives it
What takes calcium out of your bones?
Usually several things at once. Knowing which apply to you helps your team decide what to check and what to treat.
Steroids
The biggest single cause. Steroids slow the cells that build bone and reduce calcium absorbed from food. The effect grows with the dose and the length of the course.
Low sex hormones
Oestrogen and testosterone protect bone. Early menopause or low testosterone after conditioning treatment speeds up bone loss.
Worth asking about
- Missed or stopped periods
- Low energy or sex drive in men
Low vitamin D
Very common in India, even in sunny places, and more so when you stay indoors to avoid infection. Your team can check it with a blood test and advise you.
Less movement
Bones stay strong when they carry weight. Long stays in bed and weak legs mean they are loaded far less than usual.
Other medicines and the kidneys
Some anti-rejection medicines and kidney changes affect how the body handles calcium and vitamin D. Your team weighs this when planning treatment.
Not sure whether this applies to you?
Ask an oncologistThe test
What happens during a bone density scan?
Before you go
The scan is called a DEXA scan. No fasting is needed. Wear clothes without metal zips or buttons, and tell the centre if you recently had a scan with contrast dye, which can affect the reading.
Lying on the table
You lie flat on an open table while a scanning arm passes slowly over your hip and lower spine. It is quiet, and you do not go into a tunnel.
A very small dose
The scan uses low-dose X-rays, far less than a CT scan. Most people are done in a short visit and go straight home.
The report
You get a T-score for each area scanned. Your doctor reads it with your age, your steroid history and any past fractures before deciding what to do.
On your report
What does your T-score mean?
A T-score compares your bones with a healthy young adult. It is one part of the picture, not a diagnosis on its own.
What the report shows
What it usually means
T-score of -1 or above
Bone density in the normal range
T-score between -1 and -2.5
Osteopenia: bones thinner than normal, but not yet osteoporosis
T-score of -2.5 or below
Osteoporosis: bones thin enough to break more easily
A normal T-score while on steroids
Still worth watching, because steroids raise the chance of a fracture even at the same score
Protecting your bones
What can you do to protect your bones?
Much of it is daily habit, and the rest is treatment your team may offer. Both matter, and neither replaces the other.
Food and sunlight
Milk, curd, paneer, ragi, sesame and green leafy vegetables all carry calcium. Cook vegetables well and follow the food safety advice your team has given. Short periods of morning sun help vitamin D, unless GVHD or your medicines make your skin burn easily. Ask before starting any calcium or vitamin D supplement.
Weight-bearing movement
Walking, climbing stairs slowly and gentle strength work load the bones and help them rebuild. Your team will tell you what is safe for your counts.
Medicines your team may suggest
If bone loss is significant, your doctor may offer a bone-protecting medicine such as a bisphosphonate, for example alendronic acid or zoledronic acid, or hormone replacement if hormones are low. A dental check is often advised first. Only your treating team can decide if one suits you.
Who these may not suit
Some bone medicines are not used with certain kidney problems or planned dental work, and hormone replacement does not suit everyone.
Avoid smoking and alcohol. Both speed up bone loss.Leave a number, we will call you
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When to get help the same day
If you fall and then cannot stand or put weight on a leg, have sudden severe back pain after lifting, coughing or a minor knock, or notice a limb looks bent or out of shape, go to the nearest emergency department or call 108. Tell them about your transplant and your steroids. A new deep ache in the hip or groin that lasts more than a few days is not an emergency, but tell your team promptly so it can be checked.
Commonly believed
What do people often believe about bone loss?
"Bone thinning only happens to old women."
After a transplant, young men and women are affected too, mainly because of steroids and hormone changes. Age matters less than the treatment you had.
"No pain means the bones are fine."
Thinning bones cause no pain until one breaks. A density scan is the only way to know, which is why it is arranged even when you feel well.
"Drinking lots of milk will fix it."
Calcium helps, but it cannot overcome the effect of steroids or low hormones on its own. Vitamin D, movement and sometimes medicine are needed too.
"Once the bones are thin, nothing can be done."
Bone keeps rebuilding throughout life. With steroids reduced, hormones treated and the right habits, density often improves. Your doctor can repeat the scan to see how you are doing.
Questions we are asked
Common questions about bone health after a transplant
When should I have a bone density scan after my transplant?
Many transplant teams arrange one around the end of the first year, and sooner if you need long courses of steroids. Women with early menopause and anyone with a past fracture may be scanned earlier. Ask your team when your first scan is due and how often it will be repeated.
Should I stop my steroids to protect my bones?
No, not on your own. Steroids control GVHD, and stopping them suddenly can be dangerous. Your team reduces them as soon as it is safe to. In the meantime, ask what they are doing to protect your bones, such as a density scan, vitamin D checks or a bone-protecting medicine.
Can I take calcium and vitamin D tablets on my own?
Ask your team first. Vitamin D should be checked with a blood test, and too much calcium can cause kidney stones or interact with other medicines. Your doctor will tell you whether you need a supplement at all, which one, and how it fits with the rest of your medicines.
My hip hurts when I walk. Is it bone thinning?
Possibly, but a deep ache in the hip or groin after steroids can also be avascular necrosis, where the bone loses its blood supply. A density scan does not show this. Tell your team so they can arrange an X-ray or MRI. Finding it early can protect the joint.
Is walking enough exercise for my bones?
Walking is a good start. Adding gentle strength work, such as standing up from a chair repeatedly or using resistance bands, helps more. Avoid heavy lifting and deep forward bends if your bones are already thin. A physiotherapist can show you what is safe for your own scan result.
Why does the dentist need to see me before bone medicine?
Some bone-protecting medicines can rarely slow healing in the jaw after a tooth is pulled. Getting dental work done first lowers that chance. Tell your dentist about your transplant and any bone medicine, and keep up regular dental checks afterwards.
My daughter had a transplant as a child. Are her bones at risk?
They can be. Children are still building bone, and steroids, radiation or delayed puberty can reduce how strong the bones become. Her follow-up should include growth, puberty and, where advised, bone density checks. Good food, sunlight and active play all help.
Can the bone loss be reversed?
Often partly, yes. As steroids are reduced and hormones are treated, bone density can recover, especially in younger people. Medicines and habits add to this. A repeat scan shows the trend. This page cannot predict your own recovery, so ask your team what your scans show.
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Sources
- NHS — Osteoporosis: diagnosis
- NHS — Bone density scan (DEXA scan)
- National Cancer Institute — Stem cell transplants in cancer treatment
- Blood Cancer UK — Blood cancer information and support
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Hormone and Thyroid Problems After TransplantLow hormones are a major cause of bone thinningExercise and Rebuilding Strength After TransplantSafe weight-bearing movement to load your bonesLong-Term Follow-Up Schedule After TransplantWhen bone scans fit into your check-upsLife After TransplantEvery late-effects guide in one place
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Worried about your bones after transplant?
Tell us what your scans and reports show so far. Our haematology team will help you understand them and plan the right next check with your transplant centre.