Osteopenia in Children Who Have Undergone Posterior Fossa or Craniospinal Irradiation for Brain Tumors

Krishnamoorthy, Preetha; Freeman, Carolyn R.; Bernstein, Mark L.; Lawrence, Sarah; Rodd, Celia

doi:10.1001/archpedi.158.5.491

Cited by 39 publications

(25 citation statements)

References 16 publications

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“…Bone health in pediatric brain tumor patients is affected by multiple factors including endocrine dysfunction,[17-19] previous irradiation,[20,21] exogenous steroid exposure,[22,23] limited mobility,[24-27] and chronic anticonvulsant use. [28,29] Consequently, as these patients age, many are diagnosed with BMD deficits.…”

Section: Discussionmentioning

confidence: 99%

The use of bone age for bone mineral density interpretation in a cohort of pediatric brain tumor patients

et al. 2008

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Background-Skeletal bone accretion occurs throughout childhood. The integrity of this process may influence future adult bone health and risk for osteoporosis. Although surveillance of children who are at risk for poor bone accretion is important, the most appropriate method to monitor childhood bone health is not yet established. Previous investigators have proposed using bone age (BA) rather than chronologic age (CA) when interpreting bone mineral density (BMD) values in children.

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Section: Discussionmentioning

confidence: 99%

The use of bone age for bone mineral density interpretation in a cohort of pediatric brain tumor patients

et al. 2008

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“…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%

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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“…Chemotherapy can cause nausea or vomiting; alternatively, children receiving large doses of steroids may exhibit voracious appetites. Low dietary intakes of calcium and vitamin D have been reported among survivors of CNS tumors who also had significant BMD deficits [77]. Low physical activity levels both during and after treatment for childhood cancer can contribute to cardiac deconditioning and skeletal muscle atrophy [78].…”

Section: Additional Risk Factors For Bmd Deficitsmentioning

confidence: 99%

Bone Mineral Density Deficits and Fractures in Survivors of Childhood Cancer

Wilson

Ness

2013

Curr Osteoporos Rep

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Although substantial increases in survival rates among children diagnosed with cancer have been observed in recent decades, survivors are at risk of developing therapy-related chronic health conditions. Among children and adolescents treated for cancer, acquisition of peak bone mass may be compromised by cancer therapies, nutritional deficiencies and reduced physical activity. Accordingly, failure to accrue optimal bone mass during childhood may place survivors at increased risk for deficits in bone density and fracture in later life. Current recommendations for the treatment of bone density decrements among cancer survivors include dietary counseling and supplementation to ensure adequate calcium and vitamin D intake. Few strategies exist to prevent or treat bone loss. Moving forward, studies characterizing the trajectory of changes in bone density over time will facilitate the development of interventions and novel therapies aimed at minimizing bone loss among survivors of childhood cancer.

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Osteopenia in Children Who Have Undergone Posterior Fossa or Craniospinal Irradiation for Brain Tumors

Cited by 39 publications

References 16 publications

The use of bone age for bone mineral density interpretation in a cohort of pediatric brain tumor patients

The use of bone age for bone mineral density interpretation in a cohort of pediatric brain tumor patients

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

Bone Mineral Density Deficits and Fractures in Survivors of Childhood Cancer

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