[Skeletal complications in pediatric and AYA patients with acute lymphoblastic leukemia]

Advances in leukemia treatment have significantly increased the number of long-term survivors, highlighting the importance of managing late complications. Osteonecrosis and osteoporosis are major skeletal complications that can severely impair quality of life. Osteonecrosis frequently occurs in adolescents and young adults and is associated with treatments such as corticosteroids and asparaginase. Although no established preventive strategy exists, intermittent dexamethasone dosing has been linked to lower incidence. Osteoporosis characterized by ischemic necrosis is associated with decreased bone mineral density and increased risk of fragility fractures, influenced by multiple factors including the disease itself, medications, nutrition, and physical inactivity. Early evaluation and risk-based management are essential for both conditions. In addition, bone pain or fractures may be the only initial symptom of leukemia, and the patient may have bone density loss before diagnosis. Comprehensive strategies for early detection, prevention, and intervention are urgently needed. Standardized assessment tools and prospective studies are critical to improving outcomes for bone complications in leukemia survivors.