Evaluation of Bone Mineral Density at Different Phases of Therapy of Childhood All

Abstract

In the present study the authors evaluated the status of spinal bone mineral density (BMD) using dual-energy X-ray absorptiometry in a group of 31 children with acute lymphoblastic leukemia, treated by ALL-BFM protocols without irradiation, at different phases of their treatment. These patients were studied (1) within 2 months of diagnosis (group 1, n = 17, median time postdiagnosis 17 days), (2) during chemotherapy (group 2, n = 16, median time on treatment 22 months), and (3) shortly after completion of therapy (group 3, n = 10, median time postchemotherapy 13 months). Twelve patients underwent serial measurements in either of the groups they entered (6 patients of group 1 and 6 patients of group 2). The mean cumulative prednisone dose was 0.8, 4.3, and 5 g/m2 in groups 1, 2, and 3, respectively. A gradual decline of BMD from group 1 through group 3 was observed. The mean value of age- and sex-specific BMD z-score was -0.74 (+/-0.32) in group 1, -1.59 (+/-0.24) in group 2, and -2.03 (+/-0.27) in group 3; there was a statistically significant difference between groups 1 and 3 (p = .022). A BMD z-score < -2 was found in 3 (17%), 4 (25%), and 5 (50%) patients of groups 1, 2, and 3, respectively. In conclusion, a high incidence of reduced bone mass was observed during and shortly after treatment. These findings could have significant consequences in long-term survivors.

Time-Dependent Alterations in Growth and Bone Health Parameters Evaluated at Different Posttreatment Periods in Pediatric Oncology Patients

“…Rates of osteoporosis were 17%, 25%, and 50% in groups 1, 2, and 3, respectively, suggesting that osteoporosis rate increased with time, reaching the highest values by the end of treatment. Most of these studies [18,21] investigated bone health parameters at different stages of treatment, although some studies compared data obtained at diagnosis with those obtained at only 6th month of treatment [22]. The results of the present study are supported by a limited number of studies that investigated BMD at various time points after completion of treatment in a group of patients similar to our study population [7].…”

“…Arikoski et al [22] found significant decreases in BMD evaluated by DEXA in children with cancer (15 with leukemia, 12 with lymphoma, and 19 with solid tumors) 6 months after diagnosis, although they did not detect any difference between groups with regard to BMD z-scores either at diagnosis or 6 months later. Maniadaki et al [18] reported BMD zscores in children with acute lymphoblastic leukemia (ALL) as −0.74 ± 0.32, −1.59 ± 0.24, and −2.03 ± 0.27 at onset (group 1), in the course of (group 2), and at completion (group 3) of CT, respectively, and found statistically significant differences between groups 1 and 3. Rates of osteoporosis were 17%, 25%, and 50% in groups 1, 2, and 3, respectively, suggesting that osteoporosis rate increased with time, reaching the highest values by the end of treatment.…”

“…Low BMD rate, which was reported to occur within a wide range of 21% to 85% in the literature [5,6,[12][13][14][15][16][17][18][19][20], must be interpreted carefully because methods, patient groups, treatments, and follow-up durations considerably differ in the majority of the studies. In addition, lifestyle differences such as nutrition, activity, and genetic factors have not been investigated in many studies, as well as in ours.…”

Skeletal, neuromuscular and fitness impairments among children with newly diagnosed acute lymphoblastic leukemia

“…Low bone mineral density [1–5], loss of lean muscle mass [6,7], motor neuropathy [8–10], muscle weakness [7] and impaired fitness [11–15] are possible during and after therapy, and have been attributed to both leukemia and its treatment. Even though correlations between acute impairment and long-term functional loss have not been evaluated, early initiation of exercise or physical activity interventions have been proposed to restore function or to prevent impairments for children with newly diagnosed ALL [1,16–18].…”

Longitudinal Assessment of Bone Density and Structure in Childhood Survivors of Acute Lymphoblastic Leukemia without Cranial Radiation

“…Previous dual-energy x-ray absorptiometry (DXA)-based studies documented bone deficits in childhood ALL (13)(14)(15)(16)(17). However, DXA is a two-dimensional projection technique that does not provide discrete measures of trabecular and cortical bone.…”