Importance
Bone accrual during youth is critical to establish sufficient strength for lifelong skeletal health. Children with cancer may develop low bone mineral density any time before or after diagnosis.
Objective
To evaluate the ability of low magnitude, high frequency mechanical stimulation to enhance bone mineral density among childhood cancer survivors.
Design
Double-blind randomized controlled trial from June 1, 2010-January 22, 2013. Participants were randomized (stratified by sex and Tanner stage) to either a placebo device or low magnitude, high frequency mechanical stimulation.
Setting
St. Jude Children’s Research Hospital; intervention completed at home.
Participants
Survivors, ages 7-17 years, previously treated at St. Jude Children’s Research Hospital, in remission, at least five years from diagnosis, with whole body or lumbar spine bone mineral density Z-scores ≤−1.0.
Intervention
Placebo or low magnitude, high frequency mechanical stimulation (0.3 g, 32-37Hz) for two 10-minute sessions, seven days a week for one year. All participants were prescribed daily vitamin D and calcium.
Main outcome measures
Changes in areal and volumetric bone mineral density and bone biomarkers were compared by analysis of variance, adjusted for strata.
Results
Forty-eight of 65 randomized participants completed this double-blind study with median adherence of 70.1% for intervention and 63.7% for placebo groups. With intention-to-treat analysis, mean whole body bone mineral density Z-score by dual x-ray absorptiometry improved by 0.25±0.78 in the intervention (N=22), but decreased by −0.19±0.79 in the placebo group (N=26) p=0.05). Circulating osteocalcin at 12 months correlated with change in total body bone mineral density (r=0.35, p=0.02). Participants completing ≥70% of prescribed sessions increased 11.2±11.3% in tibial trabecular bone volume compared to those completing <70% who decreased −1.3±9.9% (p=0·02). Change in circulating receptor activator of nuclear factor kappa-B ligand was higher in the intervention than in the placebo group (0.06±0.16 vs. −0.04±0.17 pmol/L, p=0.04).
Conclusions and relevance
Pediatric cancer survivors with low bone mineral density may benefit from low magnitude, high frequency mechanical stimulation as a novel, safe, and convenient intervention to optimize peak bone mass during youth, alone or in conjunction with other therapies.
Trial Registration
NCT01010230. Vibration Intervention For Bone Enhancement In Childhood Cancer Survivors, www.clincialtrials.gov