Osteopenia in children surviving brain tumours

Barr, Ronald D.; Simpson, Terri; Webber, Colin E.; Gill, Gerald; Hay, John; Eves, Marilyn; Whitton, Anthony

doi:10.1016/s0959-8049(98)00011-2

Cited by 45 publications

(42 citation statements)

References 20 publications

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“…Therefore, long-term effects of hormone deficiencies could not be detected. Interestingly, a study [20] that found more pronounced decrease in bone mass among GH-deficient patients, despite replacement therapy, was conducted on average 7 years after completion of cancer treatment. Spinal irradiation is another risk factor whose demineralizing effect requires time to develop, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies of children and young adults treated for cancer during childhood or adolescence showed high rates of osteopenia and osteoporosis [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. However, few of these studies were confined to children with solid tumors, and their results were conflicting [20,21,22,23]. The discrepancies may be attributed in part to the small sample sizes and in part to the large number of factors that affect bone mineral density (BMD) in oncology patients including treatment toxicity (irradiation [4,6,7,9,10,21,22], chemotherapy agents with direct (methotrexate [24,25]) or indirect (ifosfamide [26,27]) effects on bone, glucocorticoids); prolonged immobilization or limited physical activity; malnutrition, most notably vitamin deficiencies and insufficient calcium intake [21], and secondary hormonal deficiencies (GH deficiency [17,19] and hypogonadism [5,23]).…”

Section: Introductionmentioning

confidence: 99%

“…The discrepancies may be attributed in part to the small sample sizes and in part to the large number of factors that affect bone mineral density (BMD) in oncology patients including treatment toxicity (irradiation [4,6,7,9,10,21,22], chemotherapy agents with direct (methotrexate [24,25]) or indirect (ifosfamide [26,27]) effects on bone, glucocorticoids); prolonged immobilization or limited physical activity; malnutrition, most notably vitamin deficiencies and insufficient calcium intake [21], and secondary hormonal deficiencies (GH deficiency [17,19] and hypogonadism [5,23]). Importantly, lower bone mass was associated with worse quality of life in children treated for brain tumors [20,22]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Low Bone Mineral Density and High Incidences of Fractures and Vitamin D Deficiency in 52 Pediatric Cancer Survivors

Bilariki¹,

Anagnostou²,

Masse³

et al. 2010

Horm Res Paediatr

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Objective: To evaluate bone mineral density (BMD), fractures, and vitamin D deficiency in pediatric patients in complete remission of solid tumor; and to identify risk factors for these three abnormalities. Study Design: Data were collected prospectively after completion of cancer treatment. Hormonal and vitamin D deficiencies were treated. The patients were evaluated again 1 year later. Patients: 52 consecutive patients, 30 boys and 22 girls. Among them, 21 completed the second evaluation. Measurements: A clinical examination, nutritional assessment, and laboratory workup were performed. BMD was measured by absorptiometry. Results: Calcium intake was inadequate in 75% of patients and vitamin D reserves were low in 61.5%. BMD was low at the spine in 32.7%, and at the femur in 24% of patients. Spinal and femoral BMD Z-scores correlated significantly with each other. Femoral BMD Z-score showed significant positive correlations with changes in body mass index, urinary calcium/creatinine ratio, and time since treatment completion, and a significant negative correlation with treatment duration. Fractures were noted in 10 patients but were not correlated with BMD. In the 21 re-evaluated patients, no significant improvements were found in calcium intake, vitamin D status, or BMD Z-score. Conclusions: Survivors of childhood solid cancer have high rates of insufficient calcium intake, vitamin D deficiency, low bone mass and fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low Bone Mineral Density and High Incidences of Fractures and Vitamin D Deficiency in 52 Pediatric Cancer Survivors

Bilariki¹,

Anagnostou²,

Masse³

et al. 2010

Horm Res Paediatr

View full text Add to dashboard Cite

show abstract

“…Decreased bone mineral density (BMD), which can lead to fractures, deformity, pain, and a substantial financial burden [9,10], has also been recognized in child cancer patients [11][12][13][14][15][16][17][18][19][20] and, more specifically, acute lymphoblastic leukemia (ALL) patients .…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis in Survivors of Acute Lymphoblastic Leukemia

2001

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Osteoporosis is currently receiving increasing attention as an important late effect in survivors of childhood cancer and its treatment because of their quality of life and its negative effect on the survivors' ability to perform developmentally appropriate activities. Survivors of childhood cancer are especially vulnerable because they are affected during childhood and adolescence, a time when peak bone mass should be achieved. This paper reviews decreased bone density in acute lymphoblastic leukemia (ALL), which is the most common childhood cancer and has a cure rate approaching 80%. Osteopenia/osteoporosis 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. Among the findings that have been described are musculoskeletal pain, disturbed gait, fractures, kyphosis, lordosis, and growth failure. Risk factors not specifically related to ALL include smoking, ingestion of carbonated beverages, and family history of "brittle bone" or fractures. Patients should be counseled in regard to diet, exercise, smoking cessation, and avoidance of carbonated beverages. There are a number of options for specific drug therapy; however, the administration of bisphosponates to children and adolescents must be approached with caution. Research is needed to determine how extensive the problem is and how to best prevent and treat the osteopenia/osteoporosis associated with ALL.

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“…Those who did not receive GH treatment were osteopenic at the femoral neck, lumbar spine, and Ward's triangle compared with the GH-treated patients (123). However, other published data indicate that osteopenia may be present despite GH replacement in childhood brain tumor survivors (124). Therefore, the etiology of osteopenia in this patient group is probably multifactorial.…”

Section: Chronic Diseases Of Childhood and Adolescencementioning

confidence: 83%