Is the treatment for childhood solid tumors associated with lower bone mass than that for leukemia and Hodgkin disease?
BACKGROUND
Cancer disease and its therapy (e.g., chemotherapeutic agents such as glucocorticoids, methotrexate, antymetabolities, cranial and local irradiation) may severely disturb normal growth, bone mineral acquisition, and skeletal development because most individuals go through the stages of rapid growth when childhood cancer is diagnosed.


METHODS
To identify factors associated with reduced bone mineral density (BMD) in survivors of childhood cancer the authors examined 114 patients (70 males) who had been treated for acute lymphoblastic leukemia (ALL; n = 43), Hodgkin disease (HD; n = 35), and solid tumors (ST; n = 36) twice. Median age at diagnosis was 8.4 years; at the consecutive examinations it was 12.8 and 16.3 years, respectively. To assess bone density we used dual-energy x-ray absorptiometry (DXA).


RESULTS
In the first examination, patients with a history of steroid therapy had higher total and spine BMD and higher BMI (body mass index) than those who were not given steroids. At the end of the follow-up, no differences were found in BMD between subgroups, although BMI was still higher in both ALL and HD patients than in those with ST.


CONCLUSIONS
Patients treated for solid tumors have reduced bone mass. Low BMI and local irradiation seem to be the factors responsible for reduced BMD in children treated for ST. The use of steroids does not disturb bone mass accumulation in patients treated for childhood malignancies. However, a long-term effect of cancer treatment on osteoporosis risk remains to be determined.
Muszynska-Roslan
Katarzyna
K
Department of Pediatric Oncology, Medical University of Bialystok, Bialystok, Poland. kmroslan@umwb.edu.pl
Konstantynowicz
Jerzy
J
Panasiuk
Anna
A
Krawczuk-Rybak
Maryna
M
D015502:Absorptiometry, Photon; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects* / Q000528:radiation effects; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000503:physiopathology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000503:physiopathology*; D011878:Radiotherapy / Q000009:adverse effects; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D017741:Survivors
D000970:Antineoplastic Agents; D013256:Steroids