title: Bone turnover in long-term survivors of childhood acute lymphoblastic leukemia.
abstract: BACKGROUND
  We investigated the effects of demographic, lifestyle (self-reported smoking status and physical activity levels), cancer-related treatment factors (radiation and chemotherapy), and diet (calcium and vitamin D intake) on bone turnover and the relationship of bone turnover to lumbar spine bone mineral density (BMD) Z-scores (LS-BMD Z-scores) determined by quantitative computed tomography (QCT) in 418 ≥5-year survivors of childhood acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  Bone turnover was assessed by biomarkers including serum bone-specific alkaline phosphatase (BALP), osteocalcin (OC), and urinary N-telopeptide of type I collagen indexed to creatinine (NTX/Cr). The 215 males ranged in age from 9 to 36 years (median age 17 years).
  
  
  RESULTS
  Age and tanner score were inversely associated with all biomarkers (BALP, OC, NTX/Cr) (P < 0.001). Males had higher BALP and OC than females (P < 0.001). Body mass index (BMI) was inversely associated with OC and NTX/Cr (P < 0.001). There was no significant association of biomarkers with lifestyle related factors, ALL treatment-related factors, dietary calcium, vitamin D, or LS-BMD Z-score.
  
  
  CONCLUSIONS
  In this population of long-term survivors of ALL, bone turnover was significantly associated with age, gender, tanner stage, and BMI. ALL-related treatments did not influence bone turnover and bone turnover was not predictive of volumetric LS-BMD Z-score.
authors.affiliation: Department of Cell Biology & Anatomy, Georgia Regents University, Augusta, Georgia.
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Watsky
authors.forename: Laura D
authors.initials: LD
authors.lastname: Carbone
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.forename: Cheng
authors.initials: C
authors.lastname: Cheng
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lovorn
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Sue C
authors.initials: SC
authors.lastname: Kaste
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D016723:Bone Remodeling; D002118:Calcium / Q000008:administration & dosage; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium
keywords: QCT; acute lymphoblastic leukemia survivors; bone biomarkers; bone mineral density