title: Bone mineral density after childhood cancer in 346 long-term adult survivors of childhood cancer.
abstract: CONCLUSIONS
  More than 45 % of long-term childhood cancer survivors (CCS) were diagnosed with osteopenia. Our data suggest that greater awareness for osteopenia is warranted in long-term CCS, especially in survivors who are older than 30 years, male, and underweight and were treated with cranial-spinal radiotherapy and/or steroids.
  
  
  BACKGROUND
  Osteopenia is a potential complication of childhood cancer treatment, but the magnitude of this problem in survivors is unknown. We examined (determinants of) bone mineral density (BMD) status in long-term survivors of adult childhood cancer.
  
  
  METHODS
  This retrospective single-centre cohort study included 346 subjects with the most common types of childhood cancer. Subjects had a median age at diagnosis of 7.0 years (range 0.1-16.8 years), a median age at follow-up of 24.5 years (range 18.0-47.6 years) and a median follow-up time of 16.7 years (range 5.6-39.9 years). Total body BMD (BMDTB) and BMD of the lumbar spine (BMDLS) were measured by dual X-ray absorptiometry. Osteopenia was defined as BMD standardized deviation score (SDS) below -1.
  
  
  RESULTS
  Survivors had a lower BMDTB and BMDLS (mean SDS -0.55; p<0.001 and -0.30; p<0.001, respectively) as compared to healthy peers. Osteopenia (BMDTB and/or BMDLS) was present in 45% of the survivors. Multivariate logistic regression analyses identified age at diagnosis<12 years, age>30 years at follow-up, male gender, underweight at follow-up and treatment with cranial-spinal radiotherapy or prednisone as independent prognostic factors for osteopenia.
  
  
  CONCLUSIONS
  This large cohort of childhood cancer survivors identified osteopenia in 45% of CCS. This indicates that greater awareness is warranted, especially in survivors who are older than 30 years, male, have underweight and were treated with cranial-spinal radiotherapy and/or steroids.
authors.affiliation: Department of Paediatric Oncology/Haematology, Erasmus University Medical Center (Erasmus MC)-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
authors.forename: M A H
authors.initials: MA
authors.lastname: den Hoed
authors.forename: B C
authors.initials: BC
authors.lastname: Klap
authors.forename: M L
authors.initials: ML
authors.lastname: te Winkel
authors.forename: R
authors.initials: R
authors.lastname: Pieters
authors.forename: M
authors.initials: M
authors.lastname: van Waas
authors.forename: S J C M M
authors.initials: SJ
authors.lastname: Neggers
authors.forename: A M
authors.initials: AM
authors.lastname: Boot
authors.forename: K
authors.initials: K
authors.lastname: Blijdorp
authors.forename: W
authors.initials: W
authors.lastname: van Dorp
authors.forename: S M F
authors.initials: SM
authors.lastname: Pluijm
authors.forename: M M
authors.initials: MM
authors.lastname: van den Heuvel-Eibrink
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D015519:Bone Density / Q000502:physiology; D001851:Bone Diseases, Metabolic / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult