ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Cancer. 2020;126(1):202–210. nina.kadan-lottick@yale.edu

While in healthy adults and children low BMD is associated with fracture risk, this relationship still needs to be clarified in childhood cancer survivors (CCS). This cross-sectional study analysed BMD and fracture history in 542 childhood leukaemia/lymphoma survivors, who received guideline-recommended DXA surveillance at 2 years post-therapy. 17% of survivors had low lumbar spine BMD (Z -score < −1), and 3.5% had very low BMD (Z -score < −2); 29.2% of patients who were 15- to 19-year-old at diagnosis had low BMD and 10.8% had very low BMD. Older age at diagnosis, white race, and being underweight were significantly associated with low BMD. Overall, 116 patients reported ≥1 post-therapy non-digit fracture and 25 had multiple fractures. Survivors with low BMD had greater risk of non-digit fractures (odds ratio: 2.2) and specifically long-bone fractures (odds ratio: 2.7).

The study demonstrates a significant association between low lumbar spine BMD and post-therapy fractures, emphasizing the clinical importance of routine DXA surveillance in childhood leukaemia survivors, particularly those treated in adolescence or young adulthood when peak bone mass is acquired. Interestingly, this study found no difference in the frequency of fractures and low BMD related to vitamin D/calcium status and supplementation, which differs to observations in patients with juvenile rheumatoid arthritis or idiopathic juvenile osteoporosis. Limitations of this study are its cross-sectional design and lack of data on other factors known to negatively affect BMD (sedentary lifestyle, smoking, concurrent hormonal defects as hypogonadism).

References:

1. Lovell DJ, Glass D, Ranz J, et al. A randomized controlled trial of calcium supplementation to increase bone mineral density in children with juvenile rheumatoid arthritis. Arthritis Rheum. 2006;54:2235–2242.

2. Saggese G, Bertelloni S, Baroncelli GI, Perri G, Calderazzi A. Mineral metabolism and calcitriol therapy in idiopathic juvenile osteoporosis. Am J Dis Child. 1991;145:457–62.