Bone mineral density is compromised in very long-term survivors of irradiated childhood brain tumor

Remes, Tiina; Arikoski, Pekka; Lähteenmäki, Päivi; Arola, Mikko; Pokka, Tytti; Riikonen, V. Pekka; Sirkiä, Kirsti; Rantala, Heikki; Harila‐Saari, Arja; Ojaniemi, Marja

doi:10.1080/0284186x.2018.1431401

Cited by 19 publications

(34 citation statements)

References 47 publications

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“…20) Radiation at the hypothalamicpituitary axis and total body irradiation (TBI) can lead to GH deficiency, affecting bone growth and BMD. 1,2,33) GH and insulin-like growth factor I are important for maintaining bone mass because both independently contribute to bone remodeling and apposition. 34) The severity of GH deficiency depends on patient age, dose, and fraction of radiation.…”

Section: Causative Factors Of Low Bmd In Children and Adolescents Witmentioning

confidence: 99%

“…Low BMD is a common finding among brain tumor patients treated in childhood. 33,44) Causes of low BMD are multifactorial, including craniospinal irradiation, GH deficiency, massive corticosteroids doses, and use of alkylating agents. Researchers have found that 23.6%-33% of patients with brain tumors treated in childhood had reduced BMD, with a total body BMD z-score<-2.0.…”

Section: Brain and Other Solid Tumorsmentioning

confidence: 99%

“…Researchers have found that 23.6%-33% of patients with brain tumors treated in childhood had reduced BMD, with a total body BMD z-score<-2.0. 33,44) In a case series of 28 intracranial germ cell tumor survivors, the prevalence of osteoporosis and osteopenia was 25.0% and 42.9%, respectively. In addition to radiation, risk factors included male sex, a low lean mass, and adult GH replacement.…”

Section: Brain and Other Solid Tumorsmentioning

confidence: 99%

“…Patients with a tumor in the sellar or suprasellar region such as craniopharyngioma, germinoma, or low-grade glioma are highly likely to develop growth hormone (GH) deficiency or central hypogonadism [ 20 ]. Radiation at the hypothalamic-pituitary axis and total body irradiation (TBI) can lead to GH deficiency, affecting bone growth and BMD [ 1 , 2 , 33 ]. GH and insulin-like growth factor I are important for maintaining bone mass because both independently contribute to bone remodeling and apposition [ 34 ].…”

Section: Causative Factors Of Low Bmd In Children and Adolescents Witmentioning

confidence: 99%

“…Low BMD is a common finding among brain tumor patients treated in childhood [ 33 , 44 ]. Causes of low BMD are multifactorial, including craniospinal irradiation, GH deficiency, massive corticosteroids doses, and use of alkylating agents.…”

Section: Brain and Other Solid Tumorsmentioning

confidence: 99%

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Low bone mineral density in children and adolescents with cancer

Jin

Lee

2020

Ann Pediatr Endocrinol Metab

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Maximizing accumulation of bone mass during childhood and adolescence is essential to attaining optimal peak bone mass. Childhood cancer survivors (CCS) have lower bone mineral density (BMD) than the general population. Chemotherapeutic agents including steroids and radiotherapy can affect BMD. Cancer itself, hormonal insufficiency, a poor nutritional state, and a deficit of physical activities during or after treatment also influence BMD in CCS, resulting in failure to achieve appropriate peak bone mass. Low BMD in childhood and adolescence can lead to osteoporosis in adult life and complications such as bone pain, bone deformity, and fractures. Thus, BMD in CCS should be monitored with appropriate intervention. Adequate intake of calcium and vitamin D and an increase in physical activity are recommended. Timely supplements of hormones are needed in some cases. Some publications have reported that bisphosphonate therapies using pamidronate or alendronate were well tolerated in CCS and helped increase BMD.

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Section: Causative Factors Of Low Bmd In Children and Adolescents Witmentioning

confidence: 99%

Section: Brain and Other Solid Tumorsmentioning

confidence: 99%

Section: Brain and Other Solid Tumorsmentioning

confidence: 99%

Section: Causative Factors Of Low Bmd In Children and Adolescents Witmentioning

confidence: 99%

Section: Brain and Other Solid Tumorsmentioning

confidence: 99%

See 3 more Smart Citations

Low bone mineral density in children and adolescents with cancer

Jin

Lee

2020

Ann Pediatr Endocrinol Metab

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Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations

et al. 2021

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Background Prevalent vitamin D deficiency (VDD) and low bone mineral density (BMD) have led to vitamin D supplementation for children with cancer, regardless vitamin D status. However, it remains unsettled whether this enhances bone strength. We sought to address this issue by carrying out a systematic review of the literature. Methods We conducted a literature search using PubMed, Embase, and Cochrane databases. Studies including children up to 5 years after cancer therapy were assessed for the association between 25‐hydroxyvitamin D (25OHD) levels and BMD Z‐scores or fractures, and the effect of vitamin D supplementation on BMD or fractures. Evidence quality was assessed using the GRADE methodology. Results Nineteen studies (16 observational and 3 interventional, mainly involving children with hematologic malignancies) were included. One study which analyzed 25OHD as a threshold variable (≤10 ng/ml) found a significant association between 25OHD levels and BMD Z‐scores, while 25OHD as a continuous variable was not significantly associated with BMD Z‐scores in 14 observational studies. We found neither a significant association between lower 25OHD levels and fractures (2 studies), nor between vitamin D (and calcium) supplementation and BMD or fracture frequency (3 studies) (very low quality evidence). Conclusion There is a lack of evidence for an effect of vitamin D (and calcium) supplementation on BMD or fractures in children with cancer. Further research is needed; until then, we recommend dietary vitamin D/calcium intake in keeping with standard national guidelines, and periodic 25OHD monitoring to detect levels <20 ng/ml. Vitamin D/calcium supplementation is recommended in children with low levels, to maintain levels ≥20 ng/ml year‐long.

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Factors influencing participation rates in clinical late‐effect studies of childhood cancer survivors

Helligsoe

Henriksen

Kenborg

et al. 2021

Pediatric Blood & Cancer

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To ensure external validation of a study population in clinical late-effect studies of childhood cancer, the participation rate must be high. This study investigated demographic data in Nordic late-effect studies and potential factors impacting participation rates such as cancer type, time since diagnosis, and duration of clinical examinations.We found 80 published studies originating from 16 cohorts, with median follow-up of 6.0 years (range 3-14). The overall participation rates ranged from 27% to 100%. The highest participation rates were seen in studies of survivors with solid tumors (92%) and the lowest in hematologic malignancies (67%) and central nervous system tumors (73%). The clinical examination in 10 studies (62.5%) lasted for more than 3 hours.Neither duration of the clinical examination nor time since diagnosis seemed to affect the participation rate. We encourage future studies to describe the recruitment process more thoroughly to improve understanding of the factors influencing participation rates.

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Bone mineral density is compromised in very long-term survivors of irradiated childhood brain tumor

Abstract: Low BMD should be taken in consideration in treatment of irradiated childhood brain tumor survivors especially in those with previous fractures in long bones.

Cited by 19 publications

References 47 publications

Low bone mineral density in children and adolescents with cancer

Low bone mineral density in children and adolescents with cancer

Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations

Factors influencing participation rates in clinical late‐effect studies of childhood cancer survivors

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