title: Bone Mineral Density in Survivors of Childhood Acute Lymphoblastic Leukemia
abstract: Background: The objective of this study was to evaluate bone mineral density (BMD) after completion of treatment
  for childhood acute lymphoblastic leukemia (ALL). Methods: In this cross-sectional study, 103 survivors of ALL
  aged 13.5 ± 0.45 who completed their treatment at least one year earlier were enrolled. Among these, 49.5% and
  51.5% received chemotherapy alone and chemotherapy plus cranial radiotherapy, respectively. Bone mineral content,
  BMD, and bone mineral apparent density in the lumbar spine (LS), femoral neck (FN) and forearm were assessed
  using dual-energy X-ray absorptiometry (DEXA). BMD Z-scores were classified according to International Society
  for Clinical Densitometry (ISCD) criteria. Results: The mean BMD Z-scores ± SD forLS, FN and forearm were -1.60
  ± 0.12, -1.21 ± 0.9 and -2.43 ± 0.14 respectively with significant differences (P<0.001). Considering the lowest BMD
  Z-score in LS and FN areas (at any site) and according to the ISCD classification, 62.1%, 33% and 4.9% of the patients
  had normal BMD, low BMD and osteoporosis, respectively. Also, 8.7% of patients had developed fractures after
  completion of the treatment period, 4.9% having BMD Z-Scores <-2 SD at any site. A direct relationship was apparent
  between BMD Z-scores at LS and FN at any sites and risk of fracture (P<0.001). Conclusions: ALL patients are at
  risk for low BMD and fracture. Therefore, applying DEXA scanning is recommended after completion of therapy for
  prevention of BMD reduction and osteoporosis.
authors.affiliation: Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Science, Tehran , Iran.|Department of Pediatrics, Ali-Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran. Email: grbahoush1968@gmail.com
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Rohani
authors.forename: Khadijeh
authors.initials: Kh
authors.lastname: Arjmandi Rafsanjani
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Bahoush
authors.forename: Mansoureh
authors.initials: M
authors.lastname: Sabzehparvar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ahmadi
keywords: Acute lymphoblastic leukemia; treatment; bone; chemotherapy; fracture