J Korean Med Sci.  2013 Nov;28(11):1632-1638. 10.3346/jkms.2013.28.11.1632.

Factors Related to Decreased Bone Mineral Density in Childhood Cancer Survivors

• Choi YJ
• Park SY
• Cho WK
• Lee JW
• Cho KS
• Park SH
• Hahn SH
• Jung MH
• Chung NG
• Cho B
• Suh BK
• Kim HK

• KMID: 1777661
• DOI: http://doi.org/10.3346/jkms.2013.28.11.1632

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.

Keyword

Bone Density; Neoplasms; Glucocorticoids

MeSH Terms

Adolescent
Body Mass Index
Bone Density/*drug effects
Bone Diseases, Metabolic/*chemically induced
Child
Female
Glucocorticoids/*adverse effects/*therapeutic use
Graft vs Host Disease/drug therapy
Hematopoietic Stem Cell Transplantation/adverse effects
Hormones/blood
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
Leukemia, Myeloid, Acute/pathology
Male
Osteoporosis/*chemically induced
Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
Risk Factors
Survivors
Glucocorticoids
Hormones

Figure

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  Fig. 1 BMD SDS distribution according to chronological age. CA, chronological age; LBMD, lumbar bone mineral density; FNBMD, femur neck bone mineral density; SDS, standard deviation score.

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  Fig. 2 Clinical parameters of childhood cancer survivors with low bone mineral density. LBMD SDS, lumbar bone mineral density standard deviation score; HSCT, hematopoietic stem cell transplantation; cGVHD, chronic graft-versus-host disease.

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