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Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Prospective study of changes in bone mineral density and turnover in children after hematopoietic cell
Anna Petryk1, Tracy L Bergemann, Kristen M Polga
1Department of Pediatrics, University of Minnesota, 13-124 PWB, MMC 404, 516 Delaware Street SE, Minneapolis, Minnesota 55455, USA. petry005@umn.edu
Insights
Bone loss is common in children after hematopoietic cell transplantation (HCT), with increased rates of osteopenia and osteoporosis. Osteocalcin levels at 100 days may predict recovery from bone loss.
Area of Science:
- Pediatric Hematology
- Pediatric Oncology
- Bone Metabolism
Background:
- Osteoporosis is a known complication in adults following hematopoietic cell transplantation (HCT).
- Limited data exist regarding bone mineral density (BMD) changes in pediatric patients post-HCT.
Purpose of the Study:
- To investigate the incidence, timing, magnitude, and predictors of bone loss in children after HCT.
- To assess changes in lumbar bone mineral density (LBMD) and related biomarkers.
Main Methods:
- A cohort of 49 pediatric patients (ages 5-18) undergoing HCT were evaluated.
- Lumbar BMD (LBMD) was measured using dual-energy x-ray absorptiometry at baseline, 100 days, 6 months, and 1 year post-HCT.
- Bone-specific alkaline phosphatase and osteocalcin levels were monitored.
Main Results:
- Osteopenia incidence rose from 18% to 33% and osteoporosis from 16% to 19% one year post-HCT.
- Mean LBMD z-score significantly decreased by 6 months and remained lower at 1 year, indicating substantial bone loss.
- Lower osteocalcin levels at 100 days predicted bone loss recovery, while glucocorticoid dose correlated with LBMD reduction.
Conclusions:
- Bone loss is a frequent occurrence in children post-HCT, largely attributed to suppressed bone formation.
- Osteocalcin shows potential as a predictive biomarker for bone loss recovery after HCT in children.
Context:
Osteoporosis is common in adults after hematopoietic cell transplantation (HCT). The data on bone mineral density (BMD) in children after HCT are limited.
Objective:
The objective of the study was to determine the incidence, timing, magnitude, and possible predictors of bone loss in children after HCT.
Patients And Design:
The study population included 49 patients (age 5-18 yr) who were eligible to receive HCT at the University of Minnesota. The patients were evaluated at baseline, 100 d, 6 months, and 1 yr after HCT. Lumbar BMD (LBMD) was assessed by dual-energy x-ray absorptiometry.
Results:
The number of patients with osteopenia increased from 18% at baseline to 33% 1 yr after HCT, and with osteoporosis from 16-19%. Mean areal LBMD z-score decreased from -0.56 to -1.1 by 6 months (n = 27) and at 1 yr was -0.94 (n = 21), which was significant compared with standard normal distribution (P = 0.004 and P = 0.022, respectively). The absolute loss of bone mineral corresponded to a 5.3% reduction in areal LBMD and a 4.8% reduction in volumetric LBMD. The level of bone-specific alkaline phosphatase decreased by 30% by d 100 (P = 0.009), followed by recovery toward baseline by 6 months. The level of osteocalcin greater than 6.5 ng/ml at d 100 predicted recovery from the initial bone loss by 1 yr. A reduction in LBMD at 6 months correlated with a cumulative dose of glucocorticoids.
Conclusion:
This study demonstrates that bone loss is common in children after HCT and is primarily due to suppression of bone formation. Further studies are necessary to validate osteocalcin as a predictive biomarker.
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