title: Poor bone health at the end of puberty in childhood cancer survivors.
abstract: BACKGROUND
  Although the survival rate following childhood cancer is >80%, late effects are a major concern. We aimed to determine the clinical factors affecting bone health after puberty in childhood cancer survivors at risk for low bone mineral density (BMD).
  
  
  METHODS
  We performed dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total hip regions for survivors with the following bone densitometry indications (BDIXs): brain or nasopharyngeal cancer, head or neck area radiotherapy, or corticosteroid treatment (N = 92). Additionally, we evaluated 16 survivors without these BDIXs but with other clinical factors that could affect bone health. We assessed the effects of these factors on BMD using univariate and logistic regression analyses. Moderate BMD deficit was defined as a Z-score of <-1.0 and ≥-2.0, and severe BMD deficit was defined as <-2.0.
  
  
  RESULTS
  Severe BMD deficits were found in 18 survivors (16.7%) and moderate BMD deficits were in 39 (36.1%) in at least one bone region. BMD deficits tended to increase as the number of BDIXs increased (P < 0.010). There were no severe BMD deficits in survivors without BDIXs. The duration since cancer treatment completion was correlated with higher BMD (P < 0.05). Endocrine dysfunction was a significant risk factor for decreased BMD in univariate and multivariate analyses (P < 0.05 for both).
  
  
  CONCLUSIONS
  Decreased BMD was prevalent in our study cohort. Endocrine dysfunction was found to be a significant risk factor, and it should be managed in survivors to ensure future bone health.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Jung Woo
authors.initials: JW
authors.lastname: Han
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Hyo Sun
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Hahn
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Song Lee
authors.initials: SL
authors.lastname: Jin
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Shin
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Pharmacy, Yonsei University Health System, Seoul, Korea.
authors.forename: Yoon Sun
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.|Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Chuhl Joo
authors.initials: CJ
authors.lastname: Lyu
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology; D011627:Puberty; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data
keywords: bone density; neoplasm; osteoporosis; survivor