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Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors: The
Andres Marmol-Perez1, Jose J Gil-Cosano2, Esther Ubago-Guisado3
1Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18011, Spain; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Insights
Muscle strength deficits are common in pediatric cancer survivors and linked to lower bone density. Interventions to boost muscle strength may also improve bone health in these young individuals.
Area of Science:
- Pediatric Oncology
- Bone Health
- Musculoskeletal Health
Background:
- Pediatric cancer survivors face increased risks of muscle weakness and low bone mineral density.
- Prevalence of muscle strength deficits and their link to bone mineral density (aBMD) in survivors is not well understood.
Purpose of the Study:
- To determine the prevalence of upper- and lower-body muscle strength deficits in pediatric cancer survivors.
- To examine the association between muscle strength and aBMD Z-scores across multiple skeletal sites.
Main Methods:
- Cross-sectional study of 116 pediatric cancer survivors.
- Muscle strength assessed via handgrip and standing long jump tests.
- aBMD measured using dual-energy X-ray absorptiometry; associations analyzed via multivariable regression.
Main Results:
- Over half of survivors exhibited muscle strength deficits in both upper (56.9%) and lower (60.0%) body.
- Reduced muscle strength was significantly associated with lower aBMD Z-scores at all measured sites.
- Lower muscle strength increased the odds of low aBMD by 30%-95% for upper body and 35%-70% for lower body.
Conclusions:
- Muscle strength deficits are prevalent in young pediatric cancer survivors.
- These deficits are significantly associated with reduced aBMD across all skeletal sites.
- Interventions targeting muscle strength may improve bone health in this population.
Background:
Pediatric cancer survivors are at increased risk of muscle weakness and low areal bone mineral density (aBMD). However, the prevalence of muscle strength deficits is not well documented, and the associations of muscle strength with aBMD are unknown in this population. Therefore, this study aimed to investigate the prevalence of upper- and lower-body muscle strength deficits and to examine the associations of upper- and lower-body muscle strength with age-, sex, and race-specific aBMD Z-scores at the total body, total hip, femoral neck, and lumbar spine.
Methods:
This cross-sectional study included 116 pediatric cancer survivors (12.1 ± 3.3 years old, mean ± SD; 42.2% female). Upper- and lower-body muscle strength were assessed by handgrip and standing long jump test, respectively. Dual‑energy X‑ray absorptiometry was used to measure aBMD (g/cm2). Associations between muscle strength and aBMD were evaluated in multivariable linear regression models. Logistic regression was used to evaluate the contribution of muscle strength (1-decile lower) to the odds of having low aBMD (Z-score ≤ 1.0). All analyses were adjusted for time from treatment completion, radiotherapy exposure, and body mass index.
Results:
More than one-half of survivors were within the 2 lowest deciles for upper- (56.9%) and lower- body muscle strength (60.0%) in comparison to age- and sex-specific reference values. Muscle strength deficits were associated with lower aBMD Z-scores at all sites (B = 0.133-0.258, p = 0.001-0.032). Each 1-decile lower in upper-body muscle strength was associated with 30%-95% higher odds of having low aBMD Z-scores at all sites. Each 1-decile lower in lower-body muscle strength was associated with 35%-70% higher odds of having low aBMD Z-scores at total body, total hip, and femoral neck.
Conclusion:
Muscle strength deficits are prevalent in young pediatric cancer survivors, and such deficits are associated with lower aBMD Z-scores at all sites. These results suggest that interventions designed to improve muscle strength in this vulnerable population may have the added benefit of improving aBMD.
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