Low bone mineral density and high incidences of fractures and vitamin D deficiency in 52 pediatric cancer survivors.
OBJECTIVE
To evaluate bone mineral density (BMD), fractures, and vitamin D deficiency in pediatric patients in complete remission of solid tumor; and to identify risk factors for these three abnormalities.


METHODS
Data were collected prospectively after completion of cancer treatment. Hormonal and vitamin D deficiencies were treated. The patients were evaluated again 1 year later.


METHODS
52 consecutive patients, 30 boys and 22 girls. Among them, 21 completed the second evaluation.


METHODS
A clinical examination, nutritional assessment, and laboratory workup were performed. BMD was measured by absorptiometry.


RESULTS
Calcium intake was inadequate in 75% of patients and vitamin D reserves were low in 61.5%. BMD was low at the spine in 32.7%, and at the femur in 24% of patients. Spinal and femoral BMD Z-scores correlated significantly with each other. Femoral BMD Z-score showed significant positive correlations with changes in body mass index, urinary calcium/creatinine ratio, and time since treatment completion, and a significant negative correlation with treatment duration. Fractures were noted in 10 patients but were not correlated with BMD. In the 21 re-evaluated patients, no significant improvements were found in calcium intake, vitamin D status, or BMD Z-score.


CONCLUSIONS
Survivors of childhood solid cancer have high rates of insufficient calcium intake, vitamin D deficiency, low bone mass and fractures.
Bilariki
Kalliopi
K
Endocrinologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
Anagnostou
Elli
E
Masse
Virginie
V
Elie
Caroline
C
Grill
Jacques
J
Valteau-Couanet
Dominique
D
Kalifa
Chantal
C
Doz
François
F
Sainte-Rose
Christian
C
Zerah
Michel
M
Mascard
Eric
E
Mosser
Françoise
F
Ruiz
Jean-Charles
JC
Souberbielle
Jean-Claude
JC
Eladari
Dominique
D
Brugières
Laurence
L
Polak
Michel
M
D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density / Q000502:physiology*; D001846:Bone Development / Q000502:physiology; D002118:Calcium / Q000172:deficiency; D002136:Calcium, Dietary / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006728:Hormones / Q000097:blood; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009752:Nutritional Status; D012307:Risk Factors; D012727:Sex Characteristics; D017741:Survivors; D014807:Vitamin D / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000453:epidemiology*
D002136:Calcium, Dietary; D006728:Hormones; D014807:Vitamin D; D002118:Calcium