Bone metabolism and mineralisation after cytotoxic chemotherapy including ifosfamide.

Schepper, J. De; Hachimi-Idrissi, Saı̈d; Louis, Olivia; Maurus, R.; Otten, Jacques

doi:10.1136/adc.71.4.346

Cited by 32 publications

(22 citation statements)

References 17 publications

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“…60 Although the usual treatment of such bone and soft tissue tumors includes multiagent chemotherapy, methotrexate and ifosfamide have been labeled as especially toxic to bone. 57,60 Reduction in LS aBMD and in trabecular bone at the wrist (assessed by pQCT) was identified in a large minority of survivors of malignant lymphomas and correlated significantly with the cumulative dose of corticosteroid administered. 61 Decreased Bone Mineral Density and Acute Lymphoblastic Leukemia (ALL)…”

Section: Bone Mineral Loss and Cancer In Early Lifementioning

confidence: 99%

“…In similar experiments, it was shown that vincristine, daunorubicin, etoposide, and asparaginase (all drugs used in the treatment of ALL) caused a reduction in type 1 collagen synthesis, 109 an outcome prevented by coculturing the cells with 1,25OH 2 D. Lastly, the use of ifosfamide (a drug that has been used in the treatment of relapsed ALL) was associated with osteopenia when given as a single agent to children with rhabdomyosarcoma. 60 Such alkylator therapy may contribute to osteopenia indirectly through the mechanism of hypogonadism.…”

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confidence: 99%

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Osteopenia and cancer in children and adolescents

Sala

Barr

2007

Cancer

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The attainment of a satisfactory peak bone mass, which is accomplished largely by the end of adolescence, is the best protection against excessive bone mineral loss in late adulthood. Factors that influence this process include age, race, sex, body size, pubertal status, diet, physical activity, and other lifestyle elements.Cancer and its treatment in children and teenagers adversely impact bone mineralization. In particular, chemotherapy (especially glucocorticosteroids and methotrexate) and cranial irradiation (apparently by reducing growth hormone secretion and by causing hypogonadotropic hypogonadism) interfere with normal bone turnover. Resorption often exceeds formation, resulting in net bone mineral loss and providing a rational basis for the use of antiresorptive drugs. Such osteopenia may be symptomatic, with pain and abnormal gait, and increases the risk of fractures several fold. The disorder is compounded by reduced physical activity, so programs to reduce this deficit are of measurable benefit. All of those engaged in the care of children and adolescents with cancer have an opportunity to improve the bone health of these young people and to limit their risk of developing osteoporosis and fragility fractures in adult life.

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Section: Bone Mineral Loss and Cancer In Early Lifementioning

confidence: 99%

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confidence: 99%

Osteopenia and cancer in children and adolescents

Sala

Barr

2007

Cancer

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“…Some of the cancer therapies used to treat these types of tumors seem to impair skeletal mass, including chemotherapeutic agents such as methotrexate, ifosfamide, and doxorubicin (33,34) and local radiotherapy. Methotrexate inhibits DNA synthesis, leading to a block in pyrimidine and purine synthesis.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with osteosarcoma receive high doses of methotrexate, a drug that interferes with acquisition of trabecular bone (35), as do other drugs, such as ifosfamide and bleomycin. Ifosfamide and cisplatin can also affect bone metabolism and therefore lead to osteopenia (34).…”

Section: Discussionmentioning

confidence: 99%

Reduced Bone Mineralization in Adolescent Survivors of Malignant Bone Tumors: Comparison of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry

Azcona

Burghard

Ruza

et al. 2003

Journal of Pediatric Hematology/Oncology

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Purpose: To assess bone mineralization in adolescents with bone tumors at remission using quantitative digital ultrasound (QUS) and dual-energy x-ray absorptiometry (DEXA), and to compare the bone mineralization values obtained by both methods. Methods:Patients studied were 36 adolescents (21 boys, 15 girls) who had completed treatment of a bone tumor at the University Hospital of the University of Navarra (Pamplona, Spain). QUS was performed at the distal metaphysis of the proximal phalanxes of the last four fingers of the nondominant hand. A DBM Sonic 1200 Ultrasound densitometer was used. DEXA measurements were made at the lumbar spine (vertebrae L1-L4) using the Hologic QDR 4500 W device. Calcium and vitamin D daily intake and grade of physical activity were recorded.Results: Mean age at bone mineralization determination was 19.11 years. Disease-free survival was 4.97 years. Decreased bone mineralization was observed by both methods. Bone mineralization absolute values measured by QUS and DEXA were significantly correlated. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of QUS for predicting osteopenia were 36.4%, 80.0%, 66.7%, 44.4%, and 74.1%, respectively. Daily vitamin D intake was below the recommended dietary allowances.Conclusions: Adolescents in remission from bone tumors have low bone mineralization determined by DEXA or QUS.

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“…The renal tubule damage occurring during this drug use leads to impaired phosphate resorption, and in consequence to metabolic acidosis and to phosphate and calcium loss with urine [22]. The result of this may be the BMD reduction [23] and osteomalacia [24,25] observed in children treated with IFO. Chemotherapy with IFO may also be associated with lower osteocalcin levels in blood serum [26].…”

Section: Chemotherapymentioning

confidence: 99%

Bone tissue as the site of action of oncological drugs

Leśniewski-Kmak¹,

Radecka²,

Litwiniuk³

2011

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Anticancer therapy has multiple, sometimes life-threatening side effects, and their influence on bone is not seen as important. Data have been published confirming the existence of side effects chemotherapy has on bone, which affect patients' quality of life. They influence a bone tissue not only in a direct way, but also when suppressing the activity of gonads. We have no information on the impact of drugs on bone belonging to the "targeted therapies". There are, however, some attempts to create antibodies that target proteins involved in bone physiology. Relatively well known is the impact of anti-cancer hormone therapy on bone metabolism. Bone tissue is of special importance in the pathophysiology and the clinical course of neoplastic diseases. Metastases to bones do not pose a direct threat to the patient's life, yet they markedly lower the quality of life and may be associated with complications leading to severe disability and, in consequence, to shortening of the patient's life. In the clinical picture of certain neoplasms, such as multiple myeloma, prostate cancer, thyroid cancer or sometimes breast cancer, the dominating symptoms are those related to bone infiltration. On the other hand, there are also effects of the oncological treatment on the bone -both those concerning the physiological bone cycle (of increasing importance with the observed prolongation of patient life) and the interactions between the neoplastic cells and bone cells. Below, we present a literature review on this subject. The issue of steroid therapy's effects on bones is not addressed here as the multitude of usages of this drug class resulted in the subject being already extensively discussed in other publications. ChemotherapyAdverse effects of chemotherapy concerning bones may in a longer-term perspective lead to health complaints markedly lowering the quality of life, particularly in patients with good prognosis, even more so because this approach is often combined with different hormone and radiation therapies. As early as in 1965, a report was published presenting the results of a study on the effects of methotrexate (MTX) treatment on calcium metabolism, demonstrating elevated levels of this element in urine and stool, its lowered levels in blood serum, and indirectly its increased bone resorption [1]. The above data have been reflected in a clinical setting, in patients treated with MTX for acute myeloid leukaemia, where there have been observed pain and difficult uniting of fractures during the course of treatment and remission upon its completion [2][3][4][5][6][7][8]. Although the high doses of steroids have been of significance, the cytostatic agents have been deemed to play an important role here. Reduction in the bone mineral density (BMD) has been observed as well as qualitative features of osteopenia, seen in radiograms as shrinking of the cortical bone, lower Singh index, more distinct (due to thinning) trabeculae or -in contrast -lack of the trabecular structure in imaging. Similar reports have been published base...

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Bone metabolism and mineralisation after cytotoxic chemotherapy including ifosfamide.

Cited by 32 publications

References 17 publications

Osteopenia and cancer in children and adolescents

Osteopenia and cancer in children and adolescents

Reduced Bone Mineralization in Adolescent Survivors of Malignant Bone Tumors: Comparison of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry

Bone tissue as the site of action of oncological drugs

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