Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia

Abstract

Objective: Treatment for childhood leukaemia induces many risk factors for development of decreased bone mineral density (BMD). Physical activity is also known to affect BMD. The aim was to study BMD and markers of bone turnover in a well-defined group of survivors of acute lymphoblastic leukaemia (ALL) who had all reached final height as well as peak bone mass, taking both previous treatment and physical activity into consideration. Design: All patients treated for ALL before the onset of puberty in the region of western Sweden, between 1973 and 1985, in first remission were included. Thirty-five out of forty-seven patients aged 20 -32 years participated. Nineteen patients had received cranial radiotherapy, and the median follow-up time was 20 years. Methods: BMD was assessed using dual-energy X-ray absorbtiometry (DEXA). Serum concentrations of markers of bone turnover were analysed. Physical performance was measured using a performance exercise capacity stress test. Results: BMD was slightly reduced in lumbar spine (2 0.4 SD), but not in femoral neck or total body. BMD in femoral neck was correlated to physical performance and dose of corticosteroid, but no correlation was found with spontaneous growth hormone (GH) secretion. Markers of bone turnover were also correlated to physical performance, but not to GH secretion. Conclusions: Physical fitness seems to be the most important factor in developing and preserving normal bone mineral density in ALL patients. We propose that lifestyle education promoting physical activity is encouraged from an early point in time for these patients.

Decreased bone mineral density in young adults treated with SCT in childhood: the role of 25-hydroxyvitamin D

“…In contrast with conventional ALL treatment, all patients had also received TBI, which might induce endocrine deficits, such as impaired GH secretion and hypogonadism in girls, and might also have direct effects on the BM stroma. 1,2 Jarfelt et al 22 found a low bone mass in 10 of 35 young Swedish adult survivors (29%) with a median follow-up of 20 years after conventional ALL therapy, that is, a prevalence commensurate with that observed in our transplanted patients. On the other hand, 54% of their patients had received cranial radiation therapy, which might induce impaired GH secretion and short stature, compared with 39% in the present study.…”

Long-Term Effects on Bone Mineral Density of Different Therapeutic Schemes for Acute Lymphoblastic Leukemia or Non-Hodgkin Lymphoma during Childhood

“…Intensive multimodality treatments including cytotoxic agents, glucocorticoids and radiotherapy may have direct and indirect negative effects on bone metabolism [1,6,11,13,14,15,16,17,18]. Other factors implicated in bone loss include the cancer disease itself, poor nutrition, reduced exposure to sun, and decreased physical activity during and after treatment [7,19,20]. Ultimately, insufficient bone mass acquisition and/or accelerated loss during childhood and adolescence might predispose these patients to later osteoporosis and pathologic fractures [6,11,20,21].…”

Skeletal morbidity in acute lymphoblastic leukemia of childhood: Effects on bone metabolism

“…This is notably confirmed by the fact that our controls with normal bone mass had received the same treatment. Others have also looked at bone markers in survivors [19][20][21][22] and have had the same results of no persisting abnormalities of bone mineral metabolism.…”