title: Changes in bone mineral density in newly diagnosed testicular cancer patients after anticancer treatment.
abstract: BACKGROUND
  Patients with germ cell tumors (GCTs) have an excellent prognosis but are at risk for silent fractures. Data on bone mineral density (BMD) after anticancer treatment are scarce.
  
  
  OBJECTIVE
  The objective of the study was BMD monitoring in GCT patients treated with or without chemotherapy.
  
  
  METHODS
  We prospectively studied 63 newly diagnosed GCT patients with a median age of 33 years (range 16-70 y) within 3 months of unilateral orchidectomy. Twenty-seven patients (42.9%) had no metastases. Thirty-six patients (57.1%) with metastatic disease received combination chemotherapy.
  
  
  METHODS
  This study was conducted at the outpatient clinic of a single academic institution.
  
  
  METHODS
  We performed dual-energy X-ray absorptiometry scans and collected blood samples on a yearly basis, before and up to 5 years after anticancer treatment.
  
  
  METHODS
  Changes in total hip and lumbar spine BMD, serum concentrations of gonadal hormones, and bone turnover markers were measured.
  
  
  RESULTS
  BMD remained normal in stage I patients. In patients with metastatic disease, a significant decrease in lumbar spine BMD (-1.52%; P = .004) and total hip BMD (-2.05%; P < .0001) was observed 1 year after chemotherapy and remained stable thereafter for up to 5 years. There was no significant relationship between the observed decrease in BMD and gonadal status, vitamin D status, or cumulative dose of cisplatin or (antiemetic) corticosteroids.
  
  
  CONCLUSIONS
  Metastatic GCT survivors demonstrate significant bone loss within the first year after curative combination chemotherapy, with no recovery up to 5 years after anticancer treatment. Whether this bone loss is associated with increased fracture risk and whether this could be prevented by bone modifying treatment remains to be established.
authors.affiliation: Departments of Clinical Oncology (P.M.W., S.O.) and Endocrinology and Metabolic Diseases (N.A.T.H.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands, and Centre for Human Drug Research (M.L.d.K., J.B.), 2333 CL Leiden, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Willemse
authors.forename: N A T
authors.initials: NA
authors.lastname: Hamdy
authors.forename: M L
authors.initials: ML
authors.lastname: de Kam
authors.forename: J
authors.initials: J
authors.lastname: Burggraaf
authors.forename: S
authors.initials: S
authors.lastname: Osanto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000187:drug effects*; D011859:Radiography; D013736:Testicular Neoplasms / Q000188:drug therapy*; D055815:Young Adult