Do Patients After Chondrosarcoma Treatment Have Age-appropriate Bone Mineral Density in the Long Term?

Abstract

BackgroundIn long-term survivors of osteosarcoma and Ewing sarcoma treated with the addition of radio- and chemotherapy, low bone mineral density (BMD) and fractures have been observed, presumably resulting from these adjuvants. Because patients with chondrosarcoma usually are not treated with conventional adjuvant treatment, observation of low BMD in patients with chondrosarcoma presumably would be the result of other mechanisms. However, BMD in patients with a history of chondrosarcoma has not been well characterized.Questions/PurposesThe aim of our study was to address the following questions: (1) Do long-term survivors of chondrosarcoma have normal BMD and, if not, which factors contribute to low BMD? (2) Is there a greater risk of fracture and does the Fracture Risk Assessment Tool (FRAX®) score reflect fracture likelihood?MethodsAll known patients with a history of chondrosarcoma treated at our institution before 2006 were identified. Of 127 patients believed to be alive at the time of this study, 30 agreed to participate in this study (11 females, 19 males; mean age at surgery, 39 ± 12 years; mean followup, 12 ± 5 years). With the data available, the 30 participants were not different from the 97 nonparticipants in terms of age, sex, BMI, tumor grade, tumor location (axial versus appendicular, lower extremity versus elsewhere), and use of any treatment known to influence osteopenia (chemotherapy, lower extremity surgery). BMD was measured and history of fractures was assessed using a questionnaire. The patients´ BMD measurements in this study were sex- and age-matched with a normative sex- and age-categorized reference population reported by Kudlacek et al. Associations were tested by univariate regressions and ANOVAs of all measures of BMD and eligible oncologic and demographic factors.ResultsEighteen of 30 (60%) patients had a pathologic BMD according to the WHO dual-energy x-ray absorptiometry definition, 15 (50%) had osteopenia, and three (10%) had osteoporosis. T-scores in the study cohort were lower than reference values for the femur neck (mean difference, 0.64; 95% CI, 0.27–1.01; p < 0.0015), but not for the spine (mean difference, 0.39; 95% CI, −0.06 to 0.84; p = 0.09). Thirteen patients (45%) reported a history of fractures not distinguishing between low and high impact. The incidence of fractures was 2.8 greater than expected from a comparison with a published microcensus survey of the Austrian population. No effect of the FRAX® score on fracture risk could be identified (p = 0.057).ConclusionsLong-term survivors of chondrosarcoma appear to be at greater risk for having low BMD develop than the healthy population. Although these results are preliminary and based on a very small sampling of patients, if they can be confirmed in larger studies, BMD assessment by dual-energy x-ray absorptiometry might be considered as these patients are followed posttreatment by sarcoma care units. The reasons for low BMD still must be elucidated.Level of EvidenceLevel IV, prognostic study.

Chondrosarcoma of bone: A retrospective study of surgical management of 30 cases

“…Our study also confirm this finding as majority of the patients in our study were found to be between the ages of 20 to 50 years of age and only 2 patients were seen below the age of 20 years. Similar findings were seen in the studies conducted by Gerhard M. Hobusch et al and Welkerling H et al [18,19] The most common clinical presentation of Chondrosarcoma consist of local swelling which may increase slowly or rapidly depending upon the grade of tumor. A high grade tumor is expected to grow rapidly and chances of recurrence after excision and distant metastasis is more in high grade tumor.…”

Bone health in childhood cancer: review of the literature and recommendations for the management of bone health in childhood cancer survivors

“…Chondrosarcoma is a malignant bone tumor but is uncommon in children. The standard treatment consists of a wide resection or aggressive curettage, only for selected lowgrade extremity chondrosarcomas, and is usually not followed by conventional adjuvant treatment [58]. Very little data exist on effects on bone health.…”

MicroRNA‑525 enhances chondrosarcoma malignancy by targeting F‑spondin 1

“…At present, the main treatment method for CHS is surgical resection. Thus, it is of great importance to elucidate the underlying mechanism of CHS to develop a novel therapeutic method for patients with CHS (1,19). Due to their extensive effects on cell proliferation, differentiation, apoptosis, and drug resistance, miRNAs have been revealed to be widely involved in the progression of a number of tumors (20,21).…”