Factors Related to Decreased Bone Mineral Density in Childhood Cancer Survivors

Overview

Journal J Korean Med Sci

Specialty General Medicine

Date 2013 Nov 23

PMID 24265527

Citations 8

Authors

Yun Jung Choi

Sun Young Park

Won Kyoung Cho

Jae Wook Lee

Kyoung Soon Cho

So Hyun Park

Seung Hoon Hahn

Min Ho Jung

Nack Gyun Chung

Bin Cho

Byung Kyu Suh

Hack Ki Kim

Affiliations

Soon will be listed here.

Abstract

The risk of osteoporosis or osteopenia is known to increase after childhood cancer treatment. The purpose of this study was to evaluate patterns of bone mineral density (BMD) and to identify factors related to the decreased BMD in childhood cancer survivors. We studied 78 patients (34 boys, 44 girls) treated for childhood cancer. Twenty (25.7%) patients had lumbar BMD (LBMD) standard deviation score (SDS) lower than -2. Nineteen (24.4%) patients had femur neck BMD (FNBMD) SDS lower than -2. The patients treated with hematopoietic stem cell transplantation had lower LBMD SDS (-1.17 ± 1.39 vs -0.43 ± 1.33, P = 0.025). The risk of having LBMD SDS < -2 was higher in the patients treated with glucocorticoid (GC) for graft-versus-host disease (GVHD) (36.6% vs 13.5%; odds ratio [OR], 3.7; P = 0.020). In multivariate logistic regression analysis, longer duration of GC treatment for GVHD (OR, 1.12; 95% confidence interval [CI], 1.05-1.20) and lower body mass index (BMI) SDS (OR, 0.59; 95% CI, 0.36-0.95) were associated with decreased LBMD SDS. These findings suggest that prolonged GC use and reduction in BMI are risk factors for decreased BMD in childhood cancer survivors. Anticipatory follow-up and appropriate treatment are necessary, especially for the patients with risk factors.

Citing Articles

Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives.

Rossi F, Tortora C, Paoletta M, Marrapodi M, Argenziano M, Di Paola A Cancers (Basel). 2022; 14(18).

PMID: 36139510 PMC: 9496695. DOI: 10.3390/cancers14184349.

Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group.

van Atteveld J, Mulder R, van den Heuvel-Eibrink M, Hudson M, Kremer L, Skinner R Lancet Diabetes Endocrinol. 2021; 9(9):622-637.

PMID: 34339631 PMC: 8744935. DOI: 10.1016/S2213-8587(21)00173-X.

Low bone mineral density in children and adolescents with cancer.

Jin H, Lee J Ann Pediatr Endocrinol Metab. 2020; 25(3):137-144.

PMID: 33017885 PMC: 7538298. DOI: 10.6065/apem.2040060.030.

Clinical ascertainment of health outcomes in Asian survivors of childhood cancer: a systematic review.

Poon L, Yu C, Peng L, Ewig C, Zhang H, Li C J Cancer Surviv. 2019; 13(3):374-396.

PMID: 31055708 PMC: 6548762. DOI: 10.1007/s11764-019-00759-9.

Pre-sarcopenia and bone mineral density in adults submitted to hematopoietic stem cell transplantation.

Pereira C, Amaral D, Funke V, Borba V Rev Bras Hematol Hemoter. 2017; 39(4):343-348.

PMID: 29150107 PMC: 5693394. DOI: 10.1016/j.bjhh.2017.06.005.

References

Teinturier C, Hartmann O, Valteau-Couanet D, Benhamou E, Bougneres P . Ovarian function after autologous bone marrow transplantation in childhood: high-dose busulfan is a major cause of ovarian failure. Bone Marrow Transplant. 1998; 22(10):989-94. DOI: 10.1038/sj.bmt.1701483. View

Achermann J, Hindmarsh P, Brook C . The relationship between the growth hormone and insulin-like growth factor axis in long-term survivors of childhood brain tumours. Clin Endocrinol (Oxf). 1999; 49(5):639-45. DOI: 10.1046/j.1365-2265.1998.00585.x. View

Kodama M, Komura H, Shimizu S, Hashimoto N, Mitsuda N, Kodama T . Efficacy of hormone therapy for osteoporosis in adolescent girls after hematopoietic stem cell transplantation: a longitudinal study. Fertil Steril. 2010; 95(2):731-5. DOI: 10.1016/j.fertnstert.2010.09.037. View

Dytfeld J, Ignaszak-Szczepaniak M, Gowin E, Michalak M, Horst-Sikorska W . Influence of lean and fat mass on bone mineral density (BMD) in postmenopausal women with osteoporosis. Arch Gerontol Geriatr. 2011; 53(2):e237-42. DOI: 10.1016/j.archger.2011.01.002. View

Hall G, Spector T, Griffin A, Jawad A, Hall M, Doyle D . The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis Rheum. 1993; 36(11):1510-6. DOI: 10.1002/art.1780361105. View

Thomas I, Donohue J, Ness K, Dengel D, Baker K, Gurney J . Bone mineral density in young adult survivors of acute lymphoblastic leukemia. Cancer. 2008; 113(11):3248-56. PMC: 2597561. DOI: 10.1002/cncr.23912. View

van der Sluis I, van den Heuvel-Eibrink M, Hahlen K, Krenning E, de Muinck Keizer-Schrama S . Altered bone mineral density and body composition, and increased fracture risk in childhood acute lymphoblastic leukemia. J Pediatr. 2002; 141(2):204-10. DOI: 10.1067/mpd.2002.125728. View

Manolagas S, Weinstein R . New developments in the pathogenesis and treatment of steroid-induced osteoporosis. J Bone Miner Res. 1999; 14(7):1061-6. DOI: 10.1359/jbmr.1999.14.7.1061. View

Kaste S . Bone-mineral density deficits from childhood cancer and its therapy. A review of at-risk patient cohorts and available imaging methods. Pediatr Radiol. 2004; 34(5):373-8. DOI: 10.1007/s00247-003-1132-1. View

10.

Yao S, McCarthy P, Dunford L, Roy D, Brown K, Paplham P . High prevalence of early-onset osteopenia/osteoporosis after allogeneic stem cell transplantation and improvement after bisphosphonate therapy. Bone Marrow Transplant. 2007; 41(4):393-8. DOI: 10.1038/sj.bmt.1705918. View

11.

. Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement. 2001; 17(1):1-45. View

12.

Weilbaecher K . Mechanisms of osteoporosis after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2000; 6(2A):165-74. DOI: 10.1016/s1083-8791(00)70039-5. View

13.

Patel S . Current and potential future drug treatments for osteoporosis. Ann Rheum Dis. 1996; 55(10):700-14. PMC: 1010285. DOI: 10.1136/ard.55.10.700. View

14.

Kalkwarf H, Zemel B, Gilsanz V, Lappe J, Horlick M, Oberfield S . The bone mineral density in childhood study: bone mineral content and density according to age, sex, and race. J Clin Endocrinol Metab. 2007; 92(6):2087-99. DOI: 10.1210/jc.2006-2553. View

15.

Rossner S . Childhood obesity and adulthood consequences. Acta Paediatr. 1998; 87(1):1-5. DOI: 10.1080/08035259850157778. View

16.

Frieze D . Musculoskeletal pain associated with corticosteroid therapy in cancer. Curr Pain Headache Rep. 2010; 14(4):256-60. DOI: 10.1007/s11916-010-0120-z. View

17.

Lee W, Kang M, Oh E, Oh K, Han J, Cha B . The role of cytokines in the changes in bone turnover following bone marrow transplantation. Osteoporos Int. 2002; 13(1):62-8. DOI: 10.1007/s198-002-8339-5. View

18.

Banfi A, Podesta M, Fazzuoli L, Sertoli M, Venturini M, Santini G . High-dose chemotherapy shows a dose-dependent toxicity to bone marrow osteoprogenitors: a mechanism for post-bone marrow transplantation osteopenia. Cancer. 2001; 92(9):2419-28. DOI: 10.1002/1097-0142(20011101)92:9<2419::aid-cncr1591>3.0.co;2-k. View

19.

Acott P, Wong J, Lang B, Crocker J . Pamidronate treatment of pediatric fracture patients on chronic steroid therapy. Pediatr Nephrol. 2005; 20(3):368-73. DOI: 10.1007/s00467-004-1790-8. View

20.

Turner R, Riggs B, Spelsberg T . Skeletal effects of estrogen. Endocr Rev. 1994; 15(3):275-300. DOI: 10.1210/edrv-15-3-275. View