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Bisphosphonate treatment for skeletal complications in paediatric cancer-Experience from a single tertiary centre
Pauliina Utriainen1,2, Jalmari E E Stenberg2, Kim K Vettenranta1
1Department of Pediatric Hematology and Oncology and Stem Cell Transplantation, Children's Hospital and Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Insights
Bisphosphonate treatment effectively improved bone density in pediatric cancer patients with metabolic bone complications. This therapy was well-tolerated, showing minimal adverse effects in the studied cohort.
Area of Science:
- Pediatric Oncology
- Metabolic Bone Disease
- Pharmacology
Background:
- Cancer treatments like chemotherapy and radiotherapy can lead to metabolic bone complications in children.
- These complications, including osteoporosis and osteonecrosis, significantly impact quality of life and treatment outcomes.
- Early intervention is crucial for managing bone health in pediatric cancer survivors.
Purpose of the Study:
- To evaluate the efficacy and safety of bisphosphonate treatment for metabolic bone complications in pediatric cancer patients.
- To assess the impact of bisphosphonates on bone mineral density and identify common adverse events.
Main Methods:
- Retrospective analysis of 25 pediatric cancer patients (<18 years) treated with bisphosphonates between 1999 and 2020.
- Patients had diagnoses including acute lymphoblastic leukemia and Hodgkin lymphoma, with varied treatments like stem cell transplantation and radiotherapy.
- Indications for bisphosphonates included osteoporosis, osteonecrosis, and hypercalcemia.
Main Results:
- Bisphosphonates were administered for osteoporosis (13/25), osteonecrosis (6/25), and hypercalcemia (2/25).
- Bone mineral density significantly improved (mean lumbar spine Z-score from -1.17 to -0.07, p<0.001).
- Adverse effects were mild and transient, including hypophosphatemia, hypocalcemia, and pain; no severe side effects were observed.
Conclusions:
- Bisphosphonate therapy is a safe and effective treatment for metabolic bone complications in pediatric cancer patients.
- The treatment demonstrates significant improvements in bone mineral density with a favorable safety profile.
Aims:
The aim was to analyse the use and safety of bisphosphonate treatment for metabolic bone complications in paediatric cancer patients.
Methods:
We retrospectively describe our experience with bisphosphonate treatment in 25 childhood cancer patients (aged <18 years) in a single tertiary hospital between 1999 and 2020.
Results:
The most common primary diagnosis was acute lymphoblastic leukaemia (n = 16) and Hodgkin lymphoma (n = 3). Eleven patients (44%) had received allogeneic stem cell transplantation and two patients autologous stem cell transplantation. Sixteen patients (64%) had been treated with radiotherapy, either total-body (n = 11) or local (n = 5). The main indication for bisphosphonates was osteoporosis with vertebral compression fractures in 13/25, osteonecrosis in 6/25 and hypercalcaemia in 2/25. The bisphosphonate treatment was started on average 13 (range 0-76) months after the diagnosis of the bone complication. Bisphosphonate treatment lasted between weeks (hypercalcaemia) to 5 years (severe osteoporosis). Mild, non-symptomatic hypophosphatemia (n = 8), hypocalcaemia (n = 6) and moderate, transient pain (n = 6) were the most common adverse effects. No severe side effects were observed even when bisphosphonates were administered concomitantly with chemotherapy. Bone mineral density significantly improved with the bisphosphonate treatment (mean lumbar spine Z-score -1.17 vs. -0.07, p < 0.001).
Conclusion:
Bisphosphonate treatment was well tolerated in this paediatric patient cohort.
