Bone mineral density in children with acute lymphoblastic leukaemia

Bone mineral density (BMD) may be negatively affected by the disease or its treatment in patients with acute lymphoblastic leukaemia (ALL). Therefore, we evaluated lumbar spine and total body BMD and bone metabolism in children with ALL at diagnosis, during treatment with chemotherapy and 1 year after completion of treatment. 32 children (21 boys and 11 girls) participated in the study. 14 children started the study at diagnosis and 18 during or after the treatment period. Lumbar spine and total body BMD were measured with dual energy X-ray absorptiometry, and expressed as standard deviation scores (SDS). Blood samples were obtained to assess bone metabolism. 3 of 14 children had low lumbar spine BMD (< -2 S.D.) at diagnosis. All children had normal total body BMD. Markers of bone turnover were depressed. Total body BMD SDS decreased significantly during the first year of treatment (P < 0.001). Lumbar spine BMD SDS did not change significantly. Parameters of bone turnover increased to normal during the treatment period. Parathyroid hormone had increased significantly after 1 year (P < 0.05). Mineral homeostasis was disturbed in some patients during treatment. 4 of 9 patients had low total body BMD and 1 patient low lumbar spine BMD one year after completion of treatment. All patients had normal biochemical results at that time. In conclusion, lumbar spine BMD and bone turnover were decreased in some patients at diagnosis. Total body BMD decreased significantly during treatment and was low in 4 of the 9 patients 1 year after completion of the treatment.