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. 1999 Feb;80(2):143–148. doi: 10.1136/adc.80.2.143

Reduced bone density at completion of chemotherapy for a malignancy

P Arikoski 1, J Komulainen 1, P Riikonen 1, J Jurvelin 1, R Voutilainen 1, H Kroger 1
PMCID: PMC1717834  PMID: 10325729

Abstract

OBJECTIVES—Osteoporosis and pathological fractures occur occasionally in children with malignancies. This study was performed to determine the degree of osteopenia in children with a malignancy at completion of chemotherapy. 
METHODS—Lumbar spine (L2-L4) bone mineral density (BMD; g/cm2) and femoral neck BMD were measured by dual energy x ray absorptiometry in 22 children with acute lymphoblastic leukaemia (ALL), and in 26 children with other malignancies. Apparent volumetric density was calculated to minimise the effect of bone size on BMD. Results were compared with those of 113 healthy controls and expressed as age and sex standardised mean Z scores.
RESULTS—Patients with ALL had significantly reduced lumbar volumetric (−0.77) and femoral areal and volumetric BMDs (−1.02 and −0.98, respectively). In patients with other malignancies, femoral areal and apparent volumetric BMDs were significantly decreased (−0.70 and −0.78, respectively).
CONCLUSIONS—The results demonstrate that children with a malignancy are at risk of developing osteopenia. A follow up of BMD after the completion of chemotherapy should facilitate the identification of patients who might be left with impaired development of peak bone mass, and who require specific interventions to prevent any further decrease in their skeletal mass and to preserve their BMD.



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Selected References

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  1. Aaron J. E., Francis R. M., Peacock M., Makins N. B. Contrasting microanatomy of idiopathic and corticosteroid-induced osteoporosis. Clin Orthop Relat Res. 1989 Jun;(243):294–305. [PubMed] [Google Scholar]
  2. Arikoski P., Komulainen J., Voutilainen R., Riikonen P., Parviainen M., Tapanainen P., Knip M., Kröger H. Reduced bone mineral density in long-term survivors of childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 1998 May-Jun;20(3):234–240. doi: 10.1097/00043426-199805000-00009. [DOI] [PubMed] [Google Scholar]
  3. Atkinson S. A., Fraher L., Gundberg C. M., Andrew M., Pai M., Barr R. D. Mineral homeostasis and bone mass in children treated for acute lymphoblastic leukemia. J Pediatr. 1989 May;114(5):793–800. doi: 10.1016/s0022-3476(89)80138-6. [DOI] [PubMed] [Google Scholar]
  4. Bacci G., Picci P., Ruggieri P., Mercuri M., Avella M., Capanna R., Brach Del Prever A., Mancini A., Gherlinzoni F., Padovani G. Primary chemotherapy and delayed surgery (neoadjuvant chemotherapy) for osteosarcoma of the extremities. The Istituto Rizzoli Experience in 127 patients treated preoperatively with intravenous methotrexate (high versus moderate doses) and intraarterial cisplatin. Cancer. 1990 Jun 1;65(11):2539–2553. doi: 10.1002/1097-0142(19900601)65:11<2539::aid-cncr2820651125>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  5. Carrascosa A., Gussinyé M., Yeste D., del Rio L., Audí L. Bone mass acquisition during infancy, childhood and adolescence. Acta Paediatr Suppl. 1995 Sep;411:18–23. doi: 10.1111/j.1651-2227.1995.tb13854.x. [DOI] [PubMed] [Google Scholar]
  6. Crist W., Gehan E. A., Ragab A. H., Dickman P. S., Donaldson S. S., Fryer C., Hammond D., Hays D. M., Herrmann J., Heyn R. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar;13(3):610–630. doi: 10.1200/JCO.1995.13.3.610. [DOI] [PubMed] [Google Scholar]
  7. D'Angelo P., Conter V., Di Chiara G., Rizzari C., Memeo A., Barigozzi P. Severe osteoporosis and multiple vertebral collapses in a child during treatment for B-ALL. Acta Haematol. 1993;89(1):38–42. doi: 10.1159/000204481. [DOI] [PubMed] [Google Scholar]
  8. Dempster D. W., Arlot M. A., Meunier P. J. Mean wall thickness and formation periods of trabecular bone packets in corticosteroid-induced osteoporosis. Calcif Tissue Int. 1983 Jul;35(4-5):410–417. doi: 10.1007/BF02405069. [DOI] [PubMed] [Google Scholar]
  9. Eastell R. Management of corticosteroid-induced osteoporosis. UK Consensus Group Meeting on Osteoporosis. J Intern Med. 1995 May;237(5):439–447. doi: 10.1111/j.1365-2796.1995.tb00868.x. [DOI] [PubMed] [Google Scholar]
  10. Eriksen E. F., Hodgson S. F., Eastell R., Cedel S. L., O'Fallon W. M., Riggs B. L. Cancellous bone remodeling in type I (postmenopausal) osteoporosis: quantitative assessment of rates of formation, resorption, and bone loss at tissue and cellular levels. J Bone Miner Res. 1990 Apr;5(4):311–319. doi: 10.1002/jbmr.5650050402. [DOI] [PubMed] [Google Scholar]
  11. Gaynon P. S., Lustig R. H. The use of glucocorticoids in acute lymphoblastic leukemia of childhood. Molecular, cellular, and clinical considerations. J Pediatr Hematol Oncol. 1995 Feb;17(1):1–12. doi: 10.1097/00043426-199502000-00001. [DOI] [PubMed] [Google Scholar]
  12. Geyer J. R., Zeltzer P. M., Boyett J. M., Rorke L. B., Stanley P., Albright A. L., Wisoff J. H., Milstein J. M., Allen J. C., Finlay J. L. Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNS treated with eight drugs in 1 day: a report from the Childrens Cancer Group. J Clin Oncol. 1994 Aug;12(8):1607–1615. doi: 10.1200/JCO.1994.12.8.1607. [DOI] [PubMed] [Google Scholar]
  13. Gilsanz V., Carlson M. E., Roe T. F., Ortega J. A. Osteoporosis after cranial irradiation for acute lymphoblastic leukemia. J Pediatr. 1990 Aug;117(2 Pt 1):238–244. doi: 10.1016/s0022-3476(05)80536-0. [DOI] [PubMed] [Google Scholar]
  14. Gilsanz V., Roe T. F., Gibbens D. T., Schulz E. E., Carlson M. E., Gonzalez O., Boechat M. I. Effect of sex steroids on peak bone density of growing rabbits. Am J Physiol. 1988 Oct;255(4 Pt 1):E416–E421. doi: 10.1152/ajpendo.1988.255.4.E416. [DOI] [PubMed] [Google Scholar]
  15. Green D. M., Breslow N. E., Evans I., Moksness J., Finklestein J. Z., Evans A. E., D'Angio G. J. The effect of chemotherapy dose intensity on the hematological toxicity of the treatment for Wilms' tumor. A report from the National Wilms' Tumor Study. Am J Pediatr Hematol Oncol. 1994 Aug;16(3):207–212. doi: 10.1097/00043426-199408000-00004. [DOI] [PubMed] [Google Scholar]
  16. Halton J. M., Atkinson S. A., Fraher L., Webber C. E., Cockshott W. P., Tam C., Barr R. D. Mineral homeostasis and bone mass at diagnosis in children with acute lymphoblastic leukemia. J Pediatr. 1995 Apr;126(4):557–564. doi: 10.1016/s0022-3476(95)70349-7. [DOI] [PubMed] [Google Scholar]
  17. Halton J. M., Atkinson S. A., Fraher L., Webber C., Gill G. J., Dawson S., Barr R. D. Altered mineral metabolism and bone mass in children during treatment for acute lymphoblastic leukemia. J Bone Miner Res. 1996 Nov;11(11):1774–1783. doi: 10.1002/jbmr.5650111122. [DOI] [PubMed] [Google Scholar]
  18. Henderson R. C., Madsen C. D., Davis C., Gold S. H. Bone density in survivors of childhood malignancies. J Pediatr Hematol Oncol. 1996 Nov;18(4):367–371. doi: 10.1097/00043426-199611000-00006. [DOI] [PubMed] [Google Scholar]
  19. Hunger S. P., Link M. P., Donaldson S. S. ABVD/MOPP and low-dose involved-field radiotherapy in pediatric Hodgkin's disease: the Stanford experience. J Clin Oncol. 1994 Oct;12(10):2160–2166. doi: 10.1200/JCO.1994.12.10.2160. [DOI] [PubMed] [Google Scholar]
  20. Kröger H., Kotaniemi A., Kröger L., Alhava E. Development of bone mass and bone density of the spine and femoral neck--a prospective study of 65 children and adolescents. Bone Miner. 1993 Dec;23(3):171–182. doi: 10.1016/s0169-6009(08)80094-3. [DOI] [PubMed] [Google Scholar]
  21. Kröger H., Kotaniemi A., Vainio P., Alhava E. Bone densitometry of the spine and femur in children by dual-energy x-ray absorptiometry. Bone Miner. 1992 Apr;17(1):75–85. doi: 10.1016/0169-6009(92)90712-m. [DOI] [PubMed] [Google Scholar]
  22. Lanning M., Garwicz S., Hertz H., Jonmundsson G., Kreuger A., Lie S. O., Moe P. J., Salmi T. T., Schröder H., Siimes M. A. Superior treatment results in females with high-risk acute lymphoblastic leukemia in childhood. Acta Paediatr. 1992 Jan;81(1):66–68. doi: 10.1111/j.1651-2227.1992.tb12081.x. [DOI] [PubMed] [Google Scholar]
  23. Leiper A. D., Grant D. B., Chessells J. M. Gonadal function after testicular radiation for acute lymphoblastic leukaemia. Arch Dis Child. 1986 Jan;61(1):53–56. doi: 10.1136/adc.61.1.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Leiper A. D. Management of growth failure in the treatment of malignant disease. Pediatr Hematol Oncol. 1990;7(4):365–371. doi: 10.3109/08880019009033413. [DOI] [PubMed] [Google Scholar]
  25. Lie S. O., Gustafsson G. Progress in the treatment of childhood leukaemias. Ann Med. 1992 Oct;24(5):319–323. doi: 10.3109/07853899209147830. [DOI] [PubMed] [Google Scholar]
  26. LoCascio V., Bonucci E., Imbimbo B., Ballanti P., Adami S., Milani S., Tartarotti D., DellaRocca C. Bone loss in response to long-term glucocorticoid therapy. Bone Miner. 1990 Jan;8(1):39–51. doi: 10.1016/0169-6009(91)90139-q. [DOI] [PubMed] [Google Scholar]
  27. Lund B., Storm T. L., Lund B., Melsen F., Mosekilde L., Andersen R. B., Egmose C., Sørensen O. H. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol. 1985 Jun;4(2):143–149. doi: 10.1007/BF02032284. [DOI] [PubMed] [Google Scholar]
  28. Moreira-Andrés M. N., Cañizo F. J., Papapietro K., Rejas J., Hawkins F. G. Comparison between spinal and radial bone mineral density in children measured by X-ray absorptiometry. J Pediatr Endocrinol Metab. 1995 Jan-Mar;8(1):35–41. doi: 10.1515/jpem.1995.8.1.35. [DOI] [PubMed] [Google Scholar]
  29. NEUHAUSER E. B. D., WITTENBORG M. H., BERMAN C. Z., COHEN J. Irradiation effects of roentgen therapy on the growing spine. Radiology. 1952 Nov;59(5):637–650. doi: 10.1148/59.5.637. [DOI] [PubMed] [Google Scholar]
  30. Need A. G. Corticosteroids and osteoporosis. Aust N Z J Med. 1987 Apr;17(2):267–272. doi: 10.1111/j.1445-5994.1987.tb00064.x. [DOI] [PubMed] [Google Scholar]
  31. Nussey S. S., Hyer S. L., Brada M., Leiper A. D., Pazianas M. Bone mineralization after treatment of growth hormone deficiency in survivors of childhood malignancy. Acta Paediatr Suppl. 1994 Apr;399:9–15. doi: 10.1111/j.1651-2227.1994.tb13276.x. [DOI] [PubMed] [Google Scholar]
  32. Raisz L. G. Local and systemic factors in the pathogenesis of osteoporosis. N Engl J Med. 1988 Mar 31;318(13):818–828. doi: 10.1056/NEJM198803313181305. [DOI] [PubMed] [Google Scholar]
  33. Reid I. R. Steroid osteoporosis. Calcif Tissue Int. 1989 Aug;45(2):63–67. doi: 10.1007/BF02561402. [DOI] [PubMed] [Google Scholar]
  34. Reiter A., Schrappe M., Parwaresch R., Henze G., Müller-Weihrich S., Sauter S., Sykora K. W., Ludwig W. D., Gadner H., Riehm H. Non-Hodgkin's lymphomas of childhood and adolescence: results of a treatment stratified for biologic subtypes and stage--a report of the Berlin-Frankfurt-Münster Group. J Clin Oncol. 1995 Feb;13(2):359–372. doi: 10.1200/JCO.1995.13.2.359. [DOI] [PubMed] [Google Scholar]
  35. Scheven B. A., van der Veen M. J., Damen C. A., Lafeber F. P., Van Rijn H. J., Bijlsma J. W., Duursma S. A. Effects of methotrexate on human osteoblasts in vitro: modulation by 1,25-dihydroxyvitamin D3. J Bone Miner Res. 1995 Jun;10(6):874–880. doi: 10.1002/jbmr.5650100608. [DOI] [PubMed] [Google Scholar]
  36. Schwartz A. M., Leonidas J. C. Methotrexate osteopathy. Skeletal Radiol. 1984;11(1):13–16. doi: 10.1007/BF00361126. [DOI] [PubMed] [Google Scholar]
  37. Shalet S. M. Endocrine consequences of treatment of malignant disease. Arch Dis Child. 1989 Nov;64(11):1635–1641. doi: 10.1136/adc.64.11.1635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Stanisavljevic S., Babcock A. L. Fractures in children treated with methotrexate for leukemia. Clin Orthop Relat Res. 1977 Jun;(125):139–144. [PubMed] [Google Scholar]
  39. Talvensaari K. K., Lanning M., Päkkö E., Tapanainen P., Knip M. Pituitary size assessed with magnetic resonance imaging as a measure of growth hormone secretion in long term survivors of childhood cancer. J Clin Endocrinol Metab. 1994 Oct;79(4):1122–1127. doi: 10.1210/jcem.79.4.7525626. [DOI] [PubMed] [Google Scholar]

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