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Bone health in childhood low-grade glioma: an understudied problem
I M A A van Roessel1,2, J E Gorter1,2, B Bakker1,2
1Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands.
Insights
Children with supratentorial midline low-grade glioma (LGG) have a high prevalence of low bone mineral density (BMD). Impaired vision is a significant risk factor for developing bone problems in these young patients.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Bone Health Research
Background:
- Children with supratentorial midline low-grade glioma (LGG) face risks to bone health from treatment and dysfunction.
- Impaired bone health and its severity in this pediatric population remain understudied.
Purpose of the Study:
- To determine the prevalence of bone problems in children with supratentorial midline LGG.
- To identify risk factors associated with impaired bone health in this cohort.
Main Methods:
- Retrospective study of 161 children with supratentorial midline LGG (2003-2022).
- Bone health assessed via vertebral fractures and/or bone mineral density (BMD) measurements.
- Impaired bone health defined as vertebral fractures or low BMD (≤ -2.0).
Main Results:
- 34.3% of patients exhibited low BMD.
- Vertebral fractures were present in 3.1% of patients.
- Impaired visual capacity was significantly associated with bone problems (OR: 6.63, P = 0.004).
Conclusions:
- Decreased BMD is common in children with supratentorial midline LGG.
- Visual impairment is a key risk factor for bone problems.
- Ongoing surveillance for bone health is crucial for managing these patients.
Objective:
Children with a supratentorial midline low-grade glioma (LGG) may be at risk for impaired bone health due to hypothalamic-pituitary dysfunction, obesity, exposure to multiple treatment modalities, and/or decreased mobility. The presence of impaired bone health and/or its severity in this population has been understudied. We aimed to identify the prevalence and risk factors for bone problems in children with supratentorial midline LGG.
Materials And Methods:
A retrospective study was performed in children with supratentorial midline (suprasellar or thalamic) LGG between 1 January 2003 and 1 January 2022, visiting the Princess Máxima Center for Pediatric Oncology. Impaired bone health was defined as the presence of vertebral fractures and/or very low bone mineral density (BMD).
Results:
In total, 161 children were included, with a median age at tumor diagnosis of 4.7 years (range: 0.1-17.9) and a median follow-up of 6.1 years (range: 0.1-19.9). Five patients (3.1%) had vertebral fractures. In 99 patients, BMD was assessed either by Dual Energy X-ray Absorptiometry (n = 12) or Bone Health Index (n = 95); 34 patients (34.3%) had a low BMD (≤ -2.0). Impaired visual capacity was associated with bone problems in multivariable analysis (OR: 6.63, 95% CI: 1.83-24.00, P = 0.004).
Conclusion:
In this retrospective evaluation, decreased BMD was prevalent in 34.3% of children with supratentorial midline LGG. For the risk of developing bone problems, visual capacity seems highly relevant. Surveillance of bone health must be an aspect of awareness in the care and follow-up of children with a supratentorial midline LGG.
Significance Statement:
Patients with supratentorial midline LGG may encounter various risk factors for impaired bone health. Bone problems in survivors of childhood supratentorial midline LGG are, however, understudied. This is the first paper to address the prevalence of bone problems in this specific patient population, revealing visual problems as an important risk factor. Diencephalic syndrome historyand/or weight problems associated with hypothalamic dysfunction were related to bone problems in univariate analyses. The results of this study can be used in the development of guidelines to adequately screen and treat these patients to subsequently minimizing bone problems as one of the endocrine complications.
