Bone mineral density in survivors of childhood brain tumours

Abstract

We observed that most of the patients had a BMD that was lower than normal in both the lumbar column and in the femoral neck. Bone mass loss was higher in the lumbar region rather than in the femoral neck, due to spinal radiation therapy and to the effect of hormonal deficiencies. Particularly hypogonadism, but also multiple hormonal deficiencies, are associated with lower BMD values. Experience in clinical care of these patients suggests the importance of periodic evaluations of BMD, especially in those with secondary hormone deficiencies. Moreover, the periodic assessment of the hypothalamus-pituitary function is essential for an early diagnosis of hormonal insufficiency, primarily hypogonadism, to precociously detect bone mineral loss and to prevent pathological fractures, thus improving the quality of life.

Risk factors for osteoporosis in long-term survivors of intracranial germ cell tumors

“…In conclusion, we found that 67.9% of the iGCTLS had a BMD less than −1 SD, which is a higher percentage than expected, based on the World Health Organization's report [39] and survivors of other types of brain tumor [9,10,13,20,21]. The main reason might be radiation therapy and the high prevalence of GHD.…”

“…In this study, 25.0% of the iGCTLS had osteoporosis, and 42.9% had osteopenia in all ROI. Previous studies have reported a high prevalence of BMD deficits in survivors of childhood malignancy, including brain tumors [10,13,[19][20][21]. Both the tumor itself and its treatment potentially encompass risk factors for BMD deficits such as high cumulative doses of steroids, methotrexate, cranial radiation, and testicular radiation.…”

“…Both the tumor itself and its treatment potentially encompass risk factors for BMD deficits such as high cumulative doses of steroids, methotrexate, cranial radiation, and testicular radiation. In brain tumor survivors, radiation is the most important risk factor for osteoporosis [13,20,21]. Radiation might directly affect BMD by damaging the bone marrow stroma [22].…”

“…In addition, cranial irradiation is well known to decrease bone mass through direct and indirect effects [12]. One of the probable mechanisms is through growth hormone deficiency (GHD) [13]. Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) greatly influence bone homeostasis and remodeling by stimulating the recruitment of osteoblast precursors and osteoclast bone resorption [13,14].…”

Hypopituitarism After Radiotherapy for Extracranial Head and Neck Cancers in Pediatric Patients

“…Sex hormone/sex steroid deficiencies may contribute to lowering bone mineral content and osteopenia in childhood cancer survivors. 33 Development of a pubertal disorder is common in pediatric patients after prepubertal H-P axis irradiation and can occur after cranial irradiation up to 2 years earlier in both sexes. 34 Often, the thyroid hormone and ACTH deficiencies are subtle and dominated by overt and more severe symptoms of other hormonal deficiencies.…”