Multiple Insufficient Fractures in a Woman Who Failed to Achieve Peak Bone Mass after Cancer Therapy in Adolescence

Lee, Hyeon Jeong; Kim, Dong Hwan; Kim, Seung Youn; Cho, Joong Bum; Kim, Dong Ho; Lee, Jun Ah; Lim, Jung Sub

Abstract

A 23-year-old female was brought to our pediatric clinic complainting arm and back pain. The pain developed suddenly while she was on a roller coaster and she denied any history of injuries. At First, she visited local orthopedics, and a simple X-ray showed fracture in her left forearm. She received a cast therapy, and and after several months, the fracture lesion of forearm was improved. But the pain in her arm and back still remained. Eight years ago, she was diagnosed with rhabdomyosarcoma of the left forearm and received a combination of chemotherapy and radiotherapy. She was slightly built and became increasingly thinner over the course of, chemotherapy. After completing chemotherapy, she was evaluated for bone mineral density (BMD) and was found to be osteoporotic. She was advised to take calcium supplements and exercise regular, and was assesse for BMD annually, using a duel energy X-ray absorpometry (DXA). However, her BMD did not improve and she never achieved an adequate peak bone mass. This case showed that failure to gain adequate peak bone mass during growth did not result in a later increase in bone mass in the young adult period, and finally caused multiple insufficient fractures.