Decreased bone mineral density and alteration in biochemical bone metabolism markers in children affected by bone tumors after completion of therapy

Abstract

The aim of this study was to assess bone mineral density (BMD) and biochemical bone metabolism markers in patients with bone tumors after anti-cancer treatment.The study included 27 patients (median age 15 years) with malignant bone tumors and 27 healthy children. In all subjects, BMD and body composition were measured by dual-energy X-ray absorptiometry. Serum bone markers were determined by immunoenzymatic assays. After completion of treatment, patients with bone tumors had significantly decreased total and lumbar spine BMD. We observed lower calcium and vitamin D levels in patients and comparable values of bone turnover markers (carboxyterminal telopeptide of collagen type I -CTX, bone alkaline phosphatase -BALP and osteocalcin -OC) in both groups of children. However, the level of carboxylated osteocalcin (cOC) was significantly lower (p<0.01) and undercarboxylated OC (ucOC) was higher (p<0.05) in patients than in the controls. Additionally, we observed similar values of anthropometric parameters in the subgroups of patients treated with methotrexate (MTX) or without MTX. In patients treated without MTX we found lower (p<0.05) ratio of cOC/ucOC, lower vitamin D level and higher CTX concentration.Patients with bone tumors after anticancer treatment had decreased bone mineral density and alterations in bone metabolism markers with potential decrease in bone formation.

Prevalence of low bone mineral density and risk of fractures in osteosarcoma and Ewing’s sarcoma survivors: A scoping review

“…The number of patients included in each study ranged from nine to 207 (median, 47). BMD evaluation and laboratory tests were performed during treatment or within 1 month of treatment completion in four studies [15] , [16] , [17] , [18] and at least 1 year after treatment completion in seven studies [12] , [19] , [20] , [21] , [22] , [23] , [24] . In the former publications, the mean/median age of patients ranged from 12.8 to 15.0 year, and in the latter, from 26 to 37.6 year.…”

“…Diagnosed at least one year after the completion of treatment (A), or during or within one month after the treatment (B). Please note that data are presented separately according to the diagnosis (OS or ES) or the site of DEXA scanning (lumbar spine or femur) in some studies [12] , [16] , [17] , [21] , [23] . Dx, diagnosis; Site, the site of DEXA scanning; N , the number of subjects; LS, lumbar spine; FN, femoral neck; TB, total body; NA, not available; TF, total femur; Ref, reference number.…”

“…BMD at the completion of chemotherapy was evaluated in three studies [16] , [17] , [18] . In two studies [16] , [17] , BMD was evaluated on the completion of adjuvant chemotherapy and in one [18] , after neoadjuvant chemotherapy. As summarized in Fig.…”

“…Laboratory data were evaluated in three studies [16] , [21] , [23] ; however, no bone metabolic markers were associated with BMD or recurrently identified in sarcoma patients in these studies. In contrast, serum vitamin D levels were found to be significantly lower in OS/ES survivors than in the reference value or control subjects in two studies [16] , [23] . In accordance, a relatively high proportion of OS/ES survivors had a vitamin D deficiency (78 %–88 %) [16] , [21] .…”

Endocrine late-effects and bone mineral density after combined treatment of malignant brain tumors in childhood and adolescence

“…Недостаточное питание и мальабсорбция во время лечения влекут за собой дефицит кальция и витамина D вследствие снижения их потребления и всасывания в кишечнике. Баланс кальция в крови восстанавливается путем поступления кальция из костей, усиливая таким образом снижение МПК [ 22 ].…”