Bone mineral density after childhood cancer in 346 long-term adult survivors of childhood cancer

Hoed, Marissa A. H. den; Klap, Bibi C.; Winkel, M.L. te; Pieters, Rob; Waas, Marjolein van; Neggers, Sebastian J C M M; Boot, Annemieke M.; Blijdorp, Karin; Dorp, Wendy van; Pluijm, Saskia M F; Heuvel‐Eibrink, Marry M. van den

doi:10.1007/s00198-014-2878-z

Cited by 49 publications

(52 citation statements)

References 39 publications

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“…These observations fit to previously published studies from UK where the evaluation of a General Practitioner database revealed a comparably increased risk of osteoporosis and diabetes, particularly in patients with non-Hodgkin disease. Interestingly, despite our expectations that children and adolescents would be more prone to develop late effects, especially of the bone, the frequencies of adult late effects observed in this study appear to be largely similar (5,27,28,29,30,31,32,33). There are a number of potential underlying mechanisms, which due to the nature of the study must remain speculative.…”

Section: Clinical Study J Gebauer E-m Fick and Others Endocrine Latecontrasting

confidence: 66%

Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

Gebauer

Fick

Waldmann

et al. 2015

European Journal of Endocrinology

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Objective: Due to the increasing success and survival rates in the primary treatment of malignancies derived from the CNS as well as the hematopoietic system, endocrine late effects of cancer and its therapy are of growing importance. Despite evaluation of these late effects in patients treated for cancer in childhood, the impact on adults remains largely unclear. Methods: 1035 adult patients primarily diagnosed with a CNS malignancy, a Hodgkin (HL) or non-Hodgkin lymphoma (NHL) between 1998 and 2008 were recruited via the regional epidemiological cancer registry covering w2.8 million inhabitants in the federal state of Schleswig-Holstein, Northern Germany. The prevalence of endocrine disorders and current psychosocial impairment was assessed employing several questionnaires (SF-36v1, WHO-5). Results: Fully completed questionnaires of 558 patients were available for subsequent analysis showing markedly reduced overall performance and psychological status when compared to German reference data. Thyroid disorders were reported in 16.3% of patients with 10.4% suffering from hypo-and 5.9% from hyperthyroidism. Overall, 17.6% stated to be affected by diabetes mellitus with an increased rate of 21.1% among NHL patients and 11.5% of participants were affected by osteoporosis. Conclusion: Compared to German population based studies on the prevalence of diabetes mellitus, osteoporosis and thyroid disorders the frequency of all these endocrine problems was significantly increased in CNS, HL, and NHL cancer survivors. These data confirm that not only children and adolescents but also adult cancer patients are at risk for therapy associated endocrine late effects.

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Section: Clinical Study J Gebauer E-m Fick and Others Endocrine Latecontrasting

confidence: 66%

Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

Gebauer

Fick

Waldmann

et al. 2015

European Journal of Endocrinology

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“…Only Caucasian subjects were included in the current genetic variation study in order to minimize ethnic influences on study outcome. Full details of cancer treatment were collected from the late local database, as previously described . Data on prednisone and dexamethasone dosages were available.…”

Section: Methodsmentioning

confidence: 99%

“…DXA measurements were performed in CCSs who were previously treated with corticosteroids, intensive multi‐agent chemotherapy, and/or various types of radiotherapy. Lunar Prodigy and Lunar DPX‐L were cross‐calibrated in the Erasmus MC as previously described . The BMD TB and BMD LS values of the CCSs were compared with reference values of a previously reported cohort of healthy Dutch peers and these values were expressed as age‐ and sex‐matched SDSs (Z‐score) …”

Section: Methodsmentioning

confidence: 99%

Genetic variation and bone mineral density in long‐term adult survivors of childhood cancer

Hoed

Pluijm

Stolk

et al. 2016

Pediatric Blood & Cancer

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“…Chemotherapy for pediatric acute lymphoblastic leukemia (ALL) is known to adversely impact bone density and is associated with skeletal fractures [1-4]. Recent reports have described the onset of osteotoxicity earlier than previously thought with bone changes now understood to primarily occur during active therapy [5, 6] with potential improvement for some in the years following therapy [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Early injury to cortical and cancellous bone from induction chemotherapy for adolescents and young adults treated for acute lymphoblastic leukemia

Orgel

Mueske

Wren

et al. 2016

Bone

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Diminished bone density and skeletal fractures are common morbidities during and following therapy for acute lymphoblastic leukemia (ALL). While cumulative doses of osteotoxic chemotherapy for ALL have been reported to adversely impact bone density, the timing of onset of this effect as well as other changes to bone structure are not well characterized. We therefore conducted a prospective cohort study in pre-adolescent and adolescent patients (10-21 years) newly diagnosed with ALL (n=38) to explore leukemia-related changes to bone at diagnosis and the subsequent impact of the first phase of chemotherapy (“Induction”). Using quantitative computerized tomography (QCT), we found that pre-chemotherapy bone properties were similar to age- and sex-matched controls. Subsequently over the one month Induction period, however, cancellous volumetric bone mineral density (vBMD) decreased markedly (-26.8%, p<0.001) with sparing of cortical vBMD (tibia -0.0%, p=0.860, femur -0.7%, p=0.290). The tibia underwent significant cortical thinning (average cortical thickness -1.2%, p<0.001; cortical area -0.4%, p=0.014), while the femur was less affected. Areal BMD (aBMD) concurrently measured by dual-energy X-ray absorptiometry (DXA) underestimated changes from baseline as compared to vBMD. Biochemical evidence revealed prevalent Vitamin D insufficiency and a net resorptive state at start and end of Induction. Our findings demonstrate for the first time that significant alterations to cancellous and cortical bone develop during the first month of treatment, far earlier during ALL therapy than previously considered. Given that osteotoxic chemotherapy is integral to curative regimens for ALL, these results provide reason to re-evaluate traditional approaches toward chemotherapy-associated bone toxicity and highlight the urgent need for investigation into interventions to mitigate this common adverse effect.

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Bone mineral density after childhood cancer in 346 long-term adult survivors of childhood cancer

Abstract: This large cohort of childhood cancer survivors identified osteopenia in 45% of CCS. This indicates that greater awareness is warranted, especially in survivors who are older than 30 years, male, have underweight and were treated with cranial-spinal radiotherapy and/or steroids.

Cited by 49 publications

References 39 publications

Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

Genetic variation and bone mineral density in long‐term adult survivors of childhood cancer

Early injury to cortical and cancellous bone from induction chemotherapy for adolescents and young adults treated for acute lymphoblastic leukemia

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