ESPEYB19 9. Oncology and Chronic Disease Bone health in chronic disease (2 abstracts)
9.16. Skeletal adverse events in childhood cancer survivors: An adult life after childhood cancer in Scandinavia cohort study
Oskarsson T , Duun-Henriksen AK , Bautz A , Montgomery S , Harila-Saari A , Petersen C , Niinimäki R , Madanat-Harjuoja L , Tryggvadóttir L , Holmqvist AS , Hasle H , Heyman M , Winther JF & ALiCCS study group
trausti.oskarsson@ki.se Int J Cancer. 2021; 149: 1863-1876. PMID: 34278568.
Brief Summary: This population-based study retrospectively compared hospital admissions for skeletal issues in a group of 26,334 cancer survivors (CCS) diagnosed before 20 years of age and 127,531 matched controls. 1,987 CCS vs 8,986 controls had at least one skeletal adverse event. Total hospitalization rate ratio (RR) for skeletal adverse events was higher in CCS than controls (RR 1.35).
RR for hospitalization for skeletal adverse events was increased for osteonecrosis (RR 25.9), osteoporosis (RR 4.53), fractures (RR 1.27), osteochondropathies (RR 1.57) and osteoarthrosis (RR 1.48). The RR for any skeletal adverse event in CCS was highest for the first 5 years from diagnosis (RR 1.6) and remained higher than in the general population up to age 60 years. 43% of events occurred before age 20 years, more commonly in males (8.6% vs 6.3% of females) and for the following cancer diagnoses: malignant bone tumors (RR 2.6), sympathetic nervous system tumors (RR 1.7), and leukaemia (RR 1.6). The RR of osteoporosis was higher in CCS who were 0-9 years of age at cancer diagnosis, and in patients with leukemia (RR 28.2). The RR of fractures in CCS was more elevated for serious fractures (hip RR 2.9; femur RR 2.0), than for osteoporotic fractures (proximal humerus, distal radius, distal femur, proximal tibia, pelvis and vertebrae, RR 1.4). The patterns of hospitalizations for fractures were similar among survivors and control subjects, but the expected age-dependent increase in the hospitalization rate occurred significantly earlier among cancer survivors.
An increased risk of low bone mineral density during and early after the completion of childhood cancer treatments has been reported repeatedly, but data on long-term effects and fracture risk are still conflicting. Among the strengths of this study, differently from studies based on questionnaires, skeletal adverse events were medically verified and their registration was mandatory for treating physicians. Data were cross-checked using national cancer registries and national population registries (precious resources available in the Scandinavian countries). A limitation was the lack of treatment data, in particular glucocorticoid exposure, well-known risk factor for both osteoporosis and osteonecrosis. Similarly, information about vitamin D status, nutrition, dietary calcium intake and daily physical activity was unavailable.
Volume 19
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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