title: Prevalence of vertebral fractures independent of BMD and anticancer treatment in patients with testicular germ cell tumors.
abstract: BACKGROUND
  The prognosis of testicular germ cell tumors (GCT) is excellent, and survival of GCT patients has significantly increased. However, skeletal morbidity may potentially be increased in these patients due to chemotherapy-associated hypogonadism.
  
  
  OBJECTIVE
  Our objective was assessment of skeletal fragility in testicular GCT patients.
  
  
  METHODS
  We conducted a cross-sectional study in long-term survivors and newly diagnosed patients at a single center with recruitment over a 2-yr period.
  
  
  METHODS
  We studied 199 cured long-term survivors of GCT, a mean of 7.4 yr after unilateral orchidectomy, and 45 newly diagnosed patients within 3 months of unilateral orchidectomy but before anticancer treatment. Bone mineral density (BMD) measurements were performed, and the presence of vertebral fractures (VF) was assessed in lateral thoracolumbar x-rays of the spine using the Genant's semiquantitative method.
  
  
  RESULTS
  Sixty-three patients (25.8%) had Z-scores between -1 and -2 sd, and 12 patients (5.7%) had Z-scores below -2 sd. Moderate and severe VF (grade 2 or higher) were observed in 13.6% of cured long-term survivors and in 15.6% of newly diagnosed patients. Including mild (grade 1) VF, the prevalence was 40.2 and 31.1%, respectively. There was no relationship between severity or number of VF and age, tumor type, staging, previous chemotherapy, gonadal status, vitamin D levels, or BMD values.
  
  
  CONCLUSIONS
  We identify a relatively high prevalence of mild to moderate VF independently of BMD or previous chemotherapy in long-term survivors and in newly diagnosed patients with GCT. Although the pathogenesis of these fractures remains unclear, their presence represents a potential cause of skeletal morbidity in otherwise healthy survivors of testicular GCT.
authors: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors: P M
authors: PM
authors: Willemse
authors: N A T
authors: NA
authors: Hamdy
authors: L
authors: L
authors: van Wulften
authors: A Q M J
authors: AQ
authors: van Steijn-van Tol
authors: H
authors: H
authors: Putter
authors: S
authors: S
authors: Osanto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D016103:Spinal Fractures / Q000150:complications / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D013736:Testicular Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology