Osteopenia and cancer in children and adolescents

Abstract

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.

Osteoporosis in Children and Young Adults: A Late Effect After Chemotherapy for Bone Sarcoma

“…We based our evaluation on the z-score system to compare BMD values of our young patients in conjunction with the t-score, used for the WHO osteoporosis definition [34,41]. The main difference between the two scores was the control group to which the DEXA result was related [41].…”

“…In general, we believed premature bone loss in young patients was better described as low bone density for chronologic age than with the terms osteopenia and osteoporosis [2]. Nevertheless, for reasons of simplicity and comparability, we used z-scores between À1 SD and À2 SD as osteopenia and z-scores less than À2 SD as osteoporosis [34]. None of the eight patients who received radiotherapy had DEXA measurement at the site of radiation.…”

“…These patients reportedly have lower peak bone mass with consequently lower bone mineral density (BMD) later in life, followed by premature osteopenia and/or osteoporosis, and a higher risk of osteoporotic fractures [23,34,40,41].…”

Endocrine complications in long-term survivors of childhood cancers

“…Childhood cancer survivors as a group have reduced BMD, and are at an increased risk for osteopenia, osteoporosis, and fractures (Aisenberg et al 1998, Sala & Barr 2007, Wasilewski-Masker et al 2008. This is the result of mainly three factors: the primary disease itself (Crofton et al 1998); exposure to glucocorticoids and other chemotherapeutic agents such as methotrexate (De Boer et al 1994, Stanislavejic & Babcock 1997, Brennan et al 1999, Sala & Barr 2007, Wasilewski-Masker et al 2008; and the hormonal deficiencies associated with cancer and its treatments (and described earlier in the text), GHD and sex hormone deficiencies (Aisenberg et al 1998, Nysom et al 2000, Sala & Barr 2007, Wasilewski-Masker et al 2008.…”

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

“…Children diagnosed with acute lymphoblastic leukemia (ALL) have been reported to be at increased risk of decreased bone mineral density (BMD), compared to appropriately matched healthy peers [1,2]. 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].…”