title: Assessment of bone mineral density and risk factors in children completing treatment for acute lymphoblastic leukemia.
abstract: BACKGROUND
  Reduced bone mineral density and increased fracture risk have been reported in children with cancer. In this study, we aimed to determine the growth and bone mineral density (BMD) of the children off chemotherapy for acute lymphoblastic leukemia, and the probable risk factors.
  
  
  METHODS
  The age, anthropometric measurements, lumbar spine BMDs were recorded in 70 children. The risk factors on BMD; daily calcium intake, the time interval from the completion of the chemotherapy, cranial radiotherapy, cumulative steroid dose, decrease in physical activity were investigated. Serum calcium, phosphate, alkaline phosphates, magnesium, insulin-like growth factor-1 (IGF-1) and 25 (OH) vitamin D levels were determined.
  
  
  RESULTS
  The mean height percentile at the time of diagnosis was decreased from the value of 53 to a value of 47 at the beginning of the study (P=0.071). Of them; 44% had osteoporosis, 41% had osteopenia, and the rest had normal BMD. BMD z-scores were decreased during the first 2 years from the completion of the treatment. There was a positive correlation between BMD z-scores and daily calcium intake (CC=0.366, P=0.0015). A negative correlation was determined between the time spent on TV and computers and BMD z-scores (CC=-0.464, P=0.0019). Serum IGF-1 and 25 (OH) vitamin D levels of patients were significantly lower than controls (P=0.033).
  
  
  CONCLUSIONS
  Our data revealed that 85% of the survivors had bone mineralization defect. BMDs and z scores were decreased during the first 2 years from the completion of the treatment and then gradually began to increase. The most important risk factor for decreased BMD was low daily calcium intake. Therefore, patients and their families should be encouraged to take sufficient amount of calcium. Prophylactic vitamin D may also be supplemented.
authors.affiliation: Department of Pediatric Hematology, Uludag University Faculty of Medicine, 16059 Görükle, Bursa, Turkey. adaletm@uludag.edu.tr
authors.forename: Adalet Meral
authors.initials: AM
authors.lastname: Gunes
authors.forename: Erkan
authors.initials: E
authors.lastname: Can
authors.forename: Halil
authors.initials: H
authors.lastname: Saglam
authors.forename: Yeşim Ozarda
authors.initials: YO
authors.lastname: Ilçöl
authors.forename: Birol
authors.initials: B
authors.lastname: Baytan
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D014408:Biomarkers, Tumor / Q000032:analysis; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor