High incidence of vertebral fractures in children with acute lymphoblastic leukemia 12 months after the initiation of therapy.
OBJECTIVE
Vertebral fractures due to osteoporosis are a potential complication of childhood acute lymphoblastic leukemia (ALL). To date, the incidence of vertebral fractures during ALL treatment has not been reported.


METHODS
We prospectively evaluated 155 children with ALL during the first 12 months of leukemia therapy. Lateral thoracolumbar spine radiographs were obtained at baseline and 12 months. Vertebral bodies were assessed for incident vertebral fractures using the Genant semiquantitative method, and relevant clinical indices such as spine bone mineral density (BMD), back pain, and the presence of vertebral fractures at baseline were analyzed for association with incident vertebral fractures.


RESULTS
Of the 155 children, 25 (16%; 95% CI, 11% to 23%) had a total of 61 incident vertebral fractures, of which 32 (52%) were moderate or severe. Thirteen (52%) of the 25 children with incident vertebral fractures also had fractures at baseline. Vertebral fractures at baseline increased the odds of an incident fracture at 12 months by an odds ratio of 7.3 (95% CI, 2.3 to 23.1; P = .001). In addition, for every one standard deviation reduction in spine BMD Z-score at baseline, there was 1.8-fold increased odds of incident vertebral fracture at 12 months (95% CI, 1.2 to 2.7; P = .006).


CONCLUSIONS
Children with ALL have a high incidence of vertebral fractures after 12 months of chemotherapy, and the presence of vertebral fractures and reductions in spine BMD Z-scores at baseline are highly associated clinical features.
Université de Montréal, Canada.
Nathalie
N
Alos
Ronald M
RM
Grant
Timothy
T
Ramsay
Jacqueline
J
Halton
Elizabeth A
EA
Cummings
Paivi M
PM
Miettunen
Sharon
S
Abish
Stephanie
S
Atkinson
Ronald
R
Barr
David A
DA
Cabral
Elizabeth
E
Cairney
Robert
R
Couch
David B
DB
Dix
Conrad V
CV
Fernandez
John
J
Hay
Sara
S
Israels
Caroline
C
Laverdière
Brian
B
Lentle
Victor
V
Lewis
MaryAnn
M
Matzinger
Celia
C
Rodd
Nazih
N
Shenouda
Robert
R
Stein
David
D
Stephure
Shayne
S
Taback
Beverly
B
Wilson
Kathryn
K
Williams
Frank
F
Rauch
Kerry
K
Siminoski
Leanne M
LM
Ward
D000293:Adolescent; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000453:epidemiology*; D013997:Time Factors
D005938:Glucocorticoids; D008727:Methotrexate