Reduced bone mineral density in long-term survivors of childhood acute lymphoblastic leukemia.
OBJECTIVE
Osteoporosis and pathologic fractures are occasionally found in patients with childhood acute lymphoblastic leukemia (ALL). This study was performed to determine the degree of possible osteopenia in long-term survivors of childhood ALL.


METHODS
Lumbar spine (L2-L4) and femoral neck bone mineral densities (BMDs) (g/cm2) were measured in 29 survivors (aged 12 to 30 years, median 17) of childhood ALL 2 to 20 (median 8) years after discontinuation of chemotherapy. These results were compared with those from 273 healthy controls and expressed as a percentage of the age- and sex-matched control values (mean +/- standard deviation).


RESULTS
Lumbar and femoral BMDs were significantly reduced in survivors of childhood ALL. Particularly, male gender (lumbar: 91.7 +/- 10.4%, p = 0.008; femoral: 91.9 +/- 11.3%, p = 0.005) and a history of cranial irradiation (lumbar: 93.0 +/- 8.9%, p = 0.005; femoral: 94.4 +/- 13.3%, p = 0.03) were associated with low lumbar and femoral BMDs.


CONCLUSIONS
The detected deficit in bone density in survivors of childhood ALL may predispose these patients to osteoporotic fractures later in adulthood. A follow-up of BMD in survivors of childhood ALL should facilitate the identification of patients who would require specific therapeutic interventions to prevent further decrease of their skeletal mass and preserve their BMD.
Arikoski
P
P
Department of Pediatrics, Kuopio University Hospital, Finland.
Komulainen
J
J
Voutilainen
R
R
Riikonen
P
P
Parviainen
M
M
Tapanainen
P
P
Knip
M
M
Kröger
H
H
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications / Q000175:diagnosis*; D002648:Child; D003094:Collagen / Q000097:blood; D024042:Collagen Type I; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D015675:Osteocalcin / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000503:physiopathology*; D011347:Procollagen / Q000097:blood; D012737:Sex Factors; D017741:Survivors
D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C042813:procollagen type I carboxy terminal peptide; D015675:Osteocalcin; D007334:Insulin-Like Growth Factor I; D003094:Collagen