Mineral homeostasis and bone mass at diagnosis in children with acute lymphoblastic leukemia

Halton, Jacqueline; Atkinson, Stephanie A.; Fraher, L. J.; Webber, Colin E.; Cockshott, W. Peter; Tam, Carolyn; Barr, Ronald D.

doi:10.1016/s0022-3476(95)70349-7

Cited by 140 publications

(145 citation statements)

References 22 publications

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“…62,63 This was not observed in a group of only 10 children in Finland. 51 Markers of bone formation are reduced, 51,[62][63][64][65] and at least a subset of patients have low levels of the active metabolite of vitamin D (1,25-…”

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confidence: 76%

Osteopenia and cancer in children and adolescents

Sala

Barr

2007

Cancer

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The attainment of a satisfactory peak bone mass, which is accomplished largely by the end of adolescence, is the best protection against excessive bone mineral loss in late adulthood. Factors that influence this process include age, race, sex, body size, pubertal status, diet, physical activity, and other lifestyle elements.Cancer and its treatment in children and teenagers adversely impact bone mineralization. In particular, chemotherapy (especially glucocorticosteroids and methotrexate) and cranial irradiation (apparently by reducing growth hormone secretion and by causing hypogonadotropic hypogonadism) interfere with normal bone turnover. Resorption often exceeds formation, resulting in net bone mineral loss and providing a rational basis for the use of antiresorptive drugs. Such osteopenia may be symptomatic, with pain and abnormal gait, and increases the risk of fractures several fold. The disorder is compounded by reduced physical activity, so programs to reduce this deficit are of measurable benefit. All of those engaged in the care of children and adolescents with cancer have an opportunity to improve the bone health of these young people and to limit their risk of developing osteoporosis and fragility fractures in adult life.

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confidence: 76%

Osteopenia and cancer in children and adolescents

Sala

Barr

2007

Cancer

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“…Previous studies have shown that among adult ALL survivors, hormonal deficiencies, hypogonadism, insulin resistance, and dyslipidemia are prevalent (3,4,5,6). Low bone mineral density (BMD) and osteoporosis are also recognized complications of ALL, and according to some studies, adverse skeletal effects may persist until adulthood (7,8,9,10,11,12).…”

Section: Introductionmentioning

confidence: 99%

Long-term skeletal consequences of childhood acute lymphoblastic leukemia in adult males: a cohort study

Mäkitie

Heikkinen

Toiviainen-Salo

et al. 2013

European Journal of Endocrinology

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Objective: Long-term health sequelae of childhood-onset acute lymphoblastic leukemia (ALL) remain largely unknown. Low bone mineral content (BMC) and bone mineral density (BMD) are recognized complications, but it is unknown whether these persist until adulthood. We evaluated skeletal characteristics and their association with ALL therapy in long-term male ALL survivors. Design: This cross-sectional cohort study included 49 long-term male ALL survivors and 55 agematched healthy males. Methods: BMD and compression fractures were assessed by dual-energy X-ray absorptiometry; blood biochemistry was obtained for parameters of calcium homeostasis. Results: The ALL survivors (median age 29 years, range 25-38 years), assessed 10-38 years after ALL diagnosis, had lower lumbar spine (P!0.001), femoral neck (P!0.001), and whole-body (PZ0.017) BMD than expected based on normative values. When compared with the controls (median age 30 years, range 24-36 years), the ALL survivors had lower lumbar spine BMC (PZ0.014), lower whole-body BMC (P!0.001), and lower whole-body BMD (P!0.001), but the differences were partly explained by differences in height. Altogether, 20% of the ALL survivors had spinal compression fractures, but these were equally prevalent in the controls. Males diagnosed with ALL before age 5 years had significantly lower BMD values. Other recognized risk factors included untreated hypogonadism, vitamin D deficiency, hypophosphatemia, low IGF-binding protein-3, and low physical activity. Conclusions: At young adulthood, long-term male ALL survivors have significantly reduced BMC and BMD and a high prevalence of spinal compression fractures. Careful follow-up and active treatment of the recognized risk factors are warranted.

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“…Potential etiologies for developing low bone mass in children with ALL include the disease itself [3], long-term corticosteroid use [4], chemotherapy agents including methotrexate [5], and cranial radiation [6]. There have, however, been inconsistencies in studies evaluating the effect childhood ALL and its treatment have on BMD.…”

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confidence: 99%

Total body bone measurements: A cross‐sectional study in children with acute lymphoblastic leukemia during and following completion of therapy

Kelly

Thornton

Hughes

et al. 2008

Pediatric Blood & Cancer

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BackgroundAbnormalities in bone mineral density (BMD) occur in children treated for acute lymphoblastic leukemia (ALL). However, BMD estimates have been performed using varied instruments, reference data, and interpretations. This exploratory cross sectional study to evaluate bone mass in children with ALL, uses an algorithm that serially adjusts for variables known to affect pediatric bone measures by dual energy X‐ray absorptiometry (DXA), based on models developed in 1,218 healthy children and adolescents.ProcedureAnthropometry, DXA scans, and factors with possible influence on bone mass were evaluated in 21 ALL patients receiving chemotherapy and 20 in the follow‐up phase. Main outcome was treatment group differences in Z‐scores for total body bone mineral content (BMC), bone area (Area), and areal BMD (aBMD).ResultsMean Z‐scores for the entire study population for BMC, Area, and aBMD were significantly less than zero. Among possible contributing factors, only calcium intake was a significant co‐variate. Comparison between treatment groups showed that least‐square mean Z‐scores for patients on‐therapy for at least 12 months were significantly lower than those off therapy for at least 12 months (P: 0.0008–0.044), except for BMC at last step of the algorithm (adjusted for sex, age, ethnicity, height, weight, and bone area).ConclusionsEvaluation of total body DXA by this algorithm is consistent with better general bone status in those off‐therapy. However, in this small exploratory study, the lack of significant difference between Z‐scores for fully adjusted BMC in on‐ versus off‐therapy groups suggests possible risk of low peak bone mass. Additional longitudinal evaluation is warranted. Pediatr Blood Cancer 2009;52:33–38. © 2008 Wiley‐Liss, Inc.

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Mineral homeostasis and bone mass at diagnosis in children with acute lymphoblastic leukemia

Cited by 140 publications

References 22 publications

Osteopenia and cancer in children and adolescents

Osteopenia and cancer in children and adolescents

Long-term skeletal consequences of childhood acute lymphoblastic leukemia in adult males: a cohort study

Total body bone measurements: A cross‐sectional study in children with acute lymphoblastic leukemia during and following completion of therapy

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