Early decrements in bone density after completion of neoadjuvant chemotherapy in pediatric bone sarcoma patients

Abstract

BackgroundBone mineral density (BMD) accrual during childhood and adolescence is important for attaining peak bone mass. BMD decrements have been reported in survivors of childhood bone sarcomas. However, little is known about the onset and development of bone loss during cancer treatment. The objective of this cross-sectional study was to evaluate BMD in newly diagnosed Ewing's and osteosarcoma patients by means of dual-energy x-ray absorptiometry (DXA) after completion of neoadjuvant chemotherapy.MethodsDXA measurements of the lumbar spine (L2-4), both femora and calcanei were performed perioperatively in 46 children and adolescents (mean age: 14.3 years, range: 8.6-21.5 years). Mean Z-scores, areal BMD (g/cm2), calculated volumetric BMD (g/cm3) and bone mineral content (BMC, g) were determined.ResultsLumbar spine mean Z-score was -0.14 (95% CI: -0.46 to 0.18), areal BMD was 1.016 g/cm2 (95% CI: 0.950 to 1.082) and volumetric BMD was 0.330 g/cm3 (95% CI: 0.314 to 0.347) which is comparable to healthy peers. For patients with a lower extremity tumor (n = 36), the difference between the affected and non-affected femoral neck was 12.1% (95% CI: -16.3 to -7.9) in areal BMD. The reduction of BMD was more pronounced in the calcaneus with a difference between the affected and contralateral side of 21.7% (95% CI: -29.3 to -14.0) for areal BMD. Furthermore, significant correlations for femoral and calcaneal DXA measurements were found with Spearman-rho coefficients ranging from ρ = 0.55 to ρ = 0.80.ConclusionsThe tumor disease located in the lower extremity in combination with offloading recommendations induced diminished BMD values, indicating local osteopenia conditions. However, the results revealed no significant decrements of lumbar spine BMD in pediatric sarcoma patients after completion of neoadjuvant chemotherapy. Nevertheless, it has to be taken into account that bone tumor patients may experience BMD decrements or secondary osteoporosis in later life. Furthermore, the peripheral assessment of BMD in the calcaneus via DXA is a feasible approach to quantify bone loss in the lower extremity in bone sarcoma patients and may serve as an alternative procedure, when the established assessment of femoral BMD is not practicable due to endoprosthetic replacements.

Sociooccupational and physical outcomes more than 20 years after the diagnosis of osteosarcoma in children and adolescents

“…The most frequent health issues reported were hearing loss (37%) and heart disease (29%). Regardless of surgery, survivors of osteosarcoma are likely to experience diminished bone mineral density because of polychemotherapy, a deficient nutritional status, reduced physical activity levels, a delayed onset of puberty, an increased risk of pathologic fractures, and osteoporosis later in life, 5 as well as severe limitations of the affected limb resulting in physical inactivity that increases the risk of cardiovascular disease as survivors age. 6 The cumulative incidence of second primary neoplasms in the patients in the current study at a mean of 24 years after diagnosis was 13%, and was found to be significantly higher in females and in survivors who underwent radiotherapy and had a genetic predisposition.…”

Bone mineral density deficits in childhood cancer survivors: Pathophysiology, prevalence, screening, and management

“…Osteopenia or osteoporosis was reported in 28.3% to 65% of survivors of osteogenic sarcoma or Ewing's sarcoma16,55,56). Holzer et al16).…”

Decreased bone mineral density and alteration in biochemical bone metabolism markers in children affected by bone tumors after completion of therapy

“…Lim et al (16) observed that bone tumor survivors diagnosed at a young age showed a higher prevalence of osteoporosis than survivors diagnosed at an older age (37.5% vs. 10.0%). These authors suggested that even values of z-score BMD below -1 increase the risk of fractures 2.5-fold and have important repercussions on future quality of life.…”

“…There is limited information on bone mineral density in children and adolescents affected by malignant bone tumors. Only Muller et al [16] reported that 30% of pediatric bone sarcoma patients had decreased lumbar bone mineral density (z-score BMD <-1 SD) even after preoperative chemotherapy. Most of the existing literature data on bone mineral density in bone sarcoma patients focused on adults and reported reduced BMD values and high prevalence of osteoporosis in long-term survivors [3,15,17].…”