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Longitudinal evaluation of bone mineral density in children receiving chemotherapy
R C Henderson1, C D Madsen, C Davis
1Orthopaedics and Pediatrics, University of North Carolina, Chapel Hill 27599-7055, USA.
Insights
Childhood cancer survivors may have reduced bone mineral density (BMD) at diagnosis or during treatment. Factors like cranial irradiation can worsen bone density, with limited recovery post-therapy.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Bone Metabolism
Background:
- Childhood cancer survivors often experience long-term health issues.
- Diminished bone mineral density (BMD) is a recognized complication in some survivors.
- Understanding the timing and causes of BMD deficits is crucial for intervention.
Purpose of the Study:
- To determine when bone mineral density (BMD) deficits develop in children undergoing cancer treatment.
- To investigate potential factors contributing to the development of diminished BMD.
Main Methods:
- Longitudinal monitoring of BMD in 37 pediatric cancer patients for over a year.
- Inclusion of serum vitamin D, calcium, and alkaline phosphatase levels.
- Assessment of growth parameters (height, weight) and nutritional status (skinfolds).
Main Results:
- Some patients presented with low BMD z scores at diagnosis (46% with z score < -1.0).
- A decrease of at least 0.5 standard deviations in BMD z scores occurred in 25% of patients during chemotherapy.
- Older age (>10 years), decreased height z score, and cranial irradiation were associated with BMD decline.
Conclusions:
- Reduced BMD can be present at diagnosis and may worsen during cancer treatment.
- Cranial irradiation is a potential factor influencing BMD, possibly via growth hormone disruption.
- While deficits can occur, most childhood cancer survivors do not develop severe long-term BMD loss.
Purpose:
Some children who survive a childhood malignancy have diminished bone mineral density (BMD). The purpose of this study is to assess when, and perhaps why, this problem develops.
Patients And Methods:
BMD was longitudinally monitored in 37 children for a minimum of 1 year (mean, 23.4 months; range, 12 to 41 months) during and, in some cases, after chemotherapy. Evaluations included serum analyses (vitamin D, calcium, and alkaline phosphatase), assessment of calcium intake, and measures of growth and nutrition (height, weight, and skinfolds).
Results:
BMD was already diminished at the start of treatment in some patients; 6 of 13 patients (46%) had a BMD z score in the hip or spine of < -1.0. However, only 1 patient (8%) was < -2.0. Most patients did not have a significant drop in BMD z scores during chemotherapy, but one in four did decrease at least 0.5 standard deviations. Age greater than 10 years, a drop in height z score, and treatment with cranial irradiation correlated with a drop in BMD z scores during treatment. In the year immediately after completion of chemotherapy, no consistent "catch-up" was observed in BMD z scores.
Conclusions:
In some patients, BMD z scores are diminished at the time of diagnosis and a drop may occur during treatment in others. Multiple factors related to the disease process and treatment likely contribute to these observations. Cranial irradiation, perhaps by impacting on growth hormone homeostasis, is one such factor. Fortunately, most survivors of a childhood malignancy will not have large deficits in BMD later in life.