title: The Progression of Bone Mineral Density Abnormalities After Chemotherapy for Childhood Acute Lymphoblastic Leukemia.
abstract: Although reduced bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL) is well documented, the degree of demineralization and relation to age are not well described. This is a retrospective chart analysis of 58 patients consecutively treated for ALL without relapse, cranial irradiation, or transplantation. Bone mineral densities were measured by dual-energy x-ray absorptiometry and patients were divided by sex and age (≤5, 6 to 10, and >10 y) at diagnosis. Serial scans for 6 years after therapy were analyzed as Z-scores. Over 6 years after therapy, 93.1% of patients exhibited a decreased Z-score in at least 1 anatomic site. The difference in Z-score among the age cohorts was significant at both the lumbar spine and femoral neck. Patients older than 10 years at diagnosis had the lowest Z-scores: -2.78 and -2.87 for boys and -2.39 and -2.91 for girls at the lumbar spine and femoral neck, respectively. Children after ALL therapy exhibit a significant bone mineral deficit shortly after completion of therapy that persists for at least 6 years. The degree of bone demineralization can be followed up by a dual-energy x-ray absorptiometry scan and is most severe in patients older than 10 years at the initiation of therapy.
authors.affiliation: *Department of Pediatrics, Division of Pediatric Hematology/Oncology, Stony Brook Long Island Children's Hospital †Department of Preventative Medicine, Stony Brook University, Stony Brook, NY.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Vitanza
authors.forename: Laura E
authors.initials: LE
authors.lastname: Hogan
authors.forename: Guangxiang
authors.initials: G
authors.lastname: Zhang
authors.forename: Robert I
authors.initials: RI
authors.lastname: Parker
mesh_terms: D015502:Absorptiometry, Photon; D000970:Antineoplastic Agents / Q000009:adverse effects; D015519:Bone Density / Q000187:drug effects* / Q000528:radiation effects*; D001842:Bone and Bones / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012189:Retrospective Studies; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents