ESPE Yearbook of Paediatric Endocrinology

Osteoporosis International, 2025. 36(5), 767-777. https://doi.org/10.1007/s00198-025-07458-5

Brief Summary: This systematic review and meta-analysis examined the bone mineral density (BMD) Z-scores of 4,547 childhood cancer patients and survivors. It found significant reductions in BMD Z-scores at various skeletal sites during treatment for cancer, which continued into survivorship. Hip/femoral neck BMD was more affected than lumbar spine BMD.

Commentary: Bone fragility and reduced BMD are significant long-term health concerns for childhood cancer survivors (CCS). Indeed, previous research has highlighted an elevated risk of fragility fractures in this group. This systematic review synthesises existing evidence using a three-level mixed-effects meta-analysis to examine BMD Z-scores in children undergoing cancer treatment and those who have completed it.

The findings confirm a significant decline in BMD Z-scores during treatment that continues into survivorship, particularly at the hip/femoral neck, a critical weight-bearing site. Identifying age at assessment, time since diagnosis, sex and height as moderators of hip/femoral neck BMD Z-scores provides valuable insight into risk factors. From a clinical perspective, these results emphasise the importance of regularly monitoring BMD in CCS patients and highlight the need for early interventions to mitigate bone loss. The study’s focus on hip/femoral neck BMD suggests that this site should be routinely assessed, particularly in children with limited physical activity.

Given these results, future clinical trials should evaluate the efficacy of first-line countermeasures, such as regular physical activity, targeted exercise medicine and nutrition therapy, in preventing and managing bone health decline in this population.