Cross-Sectional Study of Bone Mineral Density in Adult Survivors of Solid Pediatric Cancers

Abstract

To investigate the hypothesis that survivors of pediatric solid cancer have low bone mineral density, a cross-sectional study was done of subjects who had received treatment for pediatric solid tumors before 16 years of age and were less than 40 years old at follow-up. Excluded were subjects treated for acute lymphoblastic leukemia or those who had received cranial irradiation, total body radiation, or nonautologous bone marrow transplant. The study group consisted of 38 subjects, with the most common diagnoses being lymphoma (n = 17), sarcoma (n = 8), Wilms tumor (n = 5), and neuroblastoma (n = 4). Median age was 22 years (range 12-32). Time from diagnosis of underlying cancer averaged 12.6 years (range 5.5-20.3). Using criteria of osteopenia (Z-score < or = -1.0 and > -2.0) and osteoporosis (Z-score < or = -2.0) for any one or more areas including total body, lumbar spine, total hip, or femoral neck density, 13 of the 38 subjects (34%) had osteopenia or osteoporosis. A further six subjects (16%) had isolated upper extremity osteopenia or osteoporosis. Multivariate analysis showed a direct relationship between the number of chemotherapy drugs administered and the presence of osteopenia or osteoporosis in the lower extremities (P = 0.03). Young survivors of childhood solid tumors are at increased risk of developing premature osteopenia or osteoporosis, and screening evaluations and follow-up are warranted.

Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics

“…As index of BMD, we chose Z-score, as T-score is not suitable for females before menopause and for males younger than age 50 years (18). According to other studies describing bone deficits in CCS (18,19), the cutoff used to identify low BMD is a sex-and age-specific Z-score !K1.0.…”

Osteopenia and cancer in children and adolescents

“…However, a considerable proportion of these reports consist of small numbers of subjects who have had a wide variety of malignant diseases and an even greater heterogeneity of treatments administered, all contributing to difficulties in assessing the validity of conclusions. [48][49][50][51][52][53] Stronger evidence (Table 1) is available on survivors of primary brain tumors, osteogenic sarcoma and Ewing sarcoma, soft tissue sarcomas, and malignant lymphomas (Hodgkin and non-Hodgkin lymphomas). Survivors of brain tumors may be especially vulnerable to osteopenia as a result of growth hormone deficiency and hypogonadotropic hypogonadism due to cranial irradiation.…”

Predictors of bone loss in childhood hematologic malignancies: a prospective study

“…Such children are particularly vulnerable to nutritional deficiencies in calcium and 25-OHD due to anorexia and avoidance of sun exposure while on chemotherapy. Calcium intake when evaluated was suboptimal [19] as we have demonstrated; and in the few studies that measured vitamin D, levels were indeed low [12,[17][18][19]. Furthermore, the biological readout for low calcium absorption, be it from low nutritional intake and/or hypovitaminosis D, namely PTH, when measured was also found to be elevated in another study conducted in 20 patients with ALL [25].…”

“…Predictors of BMD deficits in survivors of childhood cancer were extensively reviewed by the Children Oncology Group [9]. The primary disease itself in acute lymphoblastic leukemia, chemotherapy including methotrexate (MTX) and glucocorticoids, and radiation therapy, were consistent predictors [9,[12][13][14]. Treatment may also lead to hypogonadism, a risk factor for low bone mass in children and adolescents [15,16].…”