title: Bone mineral density in children with acute leukemia and its associated factors in Iran: a case-control study.
abstract: Acute leukemia is the most common malignancy in children. We showed that low bone mass is prevalent among children with leukemia, especially in femur. Serum calcium, exercise, chemotherapy protocol, and radiotherapy are the main contributing factors. We suggest that early diagnosis and treatment of this problem could improve bone health in them.
  
  
  
  Acute leukemia is the most common malignancy in children and has been reported to be associated with low bone mass. Due to lack of sufficient data about the bone mineral density of children with leukemia in the Middle East, and inconsistencies between possible associated factors contributing to decreasing bone density in these children, we aimed to conduct a case-control study in Iran.
  
  
  
  This case-control study was conducted on 60 children with acute leukemia and 60 age- and sex-matched healthy controls. Anthropometric data, sun exposure, puberty, physical activity, and mineral biochemical parameters were assessed. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA). Data analysis was done by SPSS software v. 21.
  
  
  
  Serum calcium was higher in the control group (P = 0.012) while serum phosphorous, alkaline phosphatase, and serum 25(OH)D3were higher in children with leukemia with P values of 0.04, 0.002, and 0.036, respectively. Sun exposure and physical activity were more in healthy controls (P values <0.001 and 0.003, respectively). Prevalence of vitamin D deficiency in case and control groups was 57.8 and 79.4 %, respectively. This prevalence was higher in healthy controls (P value = 0.007). Both lumbar and femoral neck bone mineral apparent density (BMAD) were higher in the control group (P value <0.001). Serum calcium, physical activity, and radiotherapy were the most relevant factors associated with lumbar BMAD. Femoral neck BMAD was associated with chemotherapy protocol.
  
  
  
  Low bone mass for chronological age is prevalent among children with leukemia, especially in the femoral neck. Serum calcium, physical activity, chemotherapy protocol, and radiotherapy are the main contributing factors.
authors: Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Mohammad Reza
authors: MR
authors: Bordbar
authors: Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Sezaneh
authors: S
authors: Haghpanah
authors: Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Mohammad Hossein
authors: MH
authors: Dabbaghmanesh
authors: Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Gholamhossein Ranjbar
authors: GR
authors: Omrani
authors: Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Sakeif@sums.ac.ir.
authors: Forough
authors: F
authors: Saki
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D002118:Calcium / Q000097:blood*; D016022:Case-Control Studies; D002648:Child; D061345:Early Medical Intervention; D015444:Exercise / Q000502:physiology; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007492:Iran / Q000453:epidemiology; D007938:Leukemia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D002118:Calcium
keywords: Children; Iran; Leukemia; Low bone mass; Vitamin D