Bone mineral density in young adult survivors of acute lymphoblastic leukemia

Abstract

BACKGROUND.The purpose of the current study was to determine the prevalence of low bone mineral density (BMD) (ie, osteopenia) and identify factors associated with low BMD in young adult survivors of childhood acute lymphoblastic leukemia (ALL).METHODS.Dual energy x‐ray absorptiometry was used to evaluate BMD in 74 randomly selected, long‐term childhood ALL survivors initially treated in Minneapolis/St. Paul, Minnesota. Growth hormone (GH)‐releasing hormone–arginine stimulation testing was conducted to evaluate peak GH level, and insulin‐like growth factor I (IGF‐I) and other markers of endocrine functioning were also evaluated in relation to BMD.RESULTS.The mean age at the time of interview was 30 years, and the mean time since diagnosis was 24 years. Low BMD (Z‐score, ≤−1) was present in 24% of subjects, including 1 with osteoporosis. Low BMD was substantially more prevalent in men than in women and was strongly associated with short height. The mean height Z‐score for those with low BMD was −1.44, compared with a height Z‐score of −0.39 (P < .01) for those with normal BMD. GH insufficiency, low IGF‐I Z‐score, and current smoking were also suggestive risk factors for low BMD.CONCLUSIONS.In this long‐term follow‐up study of childhood ALL survivors, low BMD was found to be more prevalent than expected based on population normative data, specifically in men. The health consequences of early‐onset BMD problems in childhood ALL survivors need to be carefully monitored. Cancer 2008. © 2008 American Cancer Society.

Long-term skeletal consequences of childhood acute lymphoblastic leukemia in adult males: a cohort study

“…Previous studies have shown that among adult ALL survivors, hormonal deficiencies, hypogonadism, insulin resistance, and dyslipidemia are prevalent (3,4,5,6). Low bone mineral density (BMD) and osteoporosis are also recognized complications of ALL, and according to some studies, adverse skeletal effects may persist until adulthood (7,8,9,10,11,12).…”

Are Survivors of Childhood Acute Lymphoblastic Leukemia at Increased Risk for Low Bone Mass?

“…As an increasing number of cancer survivors reaches adulthood, there may be consequences of the treatment, including adiposity, metabolic syndrome traits [2][3][4][5][6][7][8][9] and occasionally low bone mass [10][11][12][13][14][15][16][17][18], which is a condition not totally understood, so far.…”

“…Cancer survivors, particularly ALL patients, are part of one of these important groups and there are several important concerns regarding their bone heath [10][11][12][13][14][15][16][17][18][19]. Low bone mass has been observed in all phases of the disease: at diagnosis, during treatment, and throughout the post-treatment period for as long as 20 years [21].…”

“…Several pediatric conditions may have an increased risk for low bone mass, which is attributed to the disease itself, genetic characteristics, intensive therapy against the disease [10][11][12][13][14][15][16][17][18][19], as well as body composition modifications [20]. Cancer survivors, particularly ALL patients, are part of one of these important groups and there are several important concerns regarding their bone heath [10][11][12][13][14][15][16][17][18][19].…”

Endocrine health problems detected in 764 patients evaluated in a late effects clinic

“…Screening for low body mineral density is recommended for survivors treated with hematopoietic stem cell transplant, methotrexate, and steroids. Problems with growth [4], weight [5], puberty and gonadal function [6], bone health [7], thyroid function [8], and adrenal function [9] have been described.…”