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Osteopenia and avascular necrosis (AVN) of the hip or other joints are well described late bone effects of HCT which may occur as a result of corticosteroid therapy for GVHD [45]. AVN occurs frequently post‐HCT, and about 4–10% of the patients may be affected with at least one joint with AVN [46]. Vitamin D, plus calcium supplementation and annual dual‐energy X‐ray absorptiometry scans, for bone health are described in detail in Chapter 15.

Common late musculoskeletal effects include steroid‐induced myopathy, fasciitis/scleroderma, and polymyositis, and up to one‐third of patients may report musculoskeletal symptoms even after 10 years of HCT [47]. Sclerosis as a manifestation of cGVHD can affect the skin and subcutaneous tissues, including fasciae and joints. Prompt recognition of these complications by clinical examinations, serology, and neurologic studies and early intervention may prevent permanent disability.