Reduced Bone Mineralization in Adolescent Survivors of Malignant Bone Tumors: Comparison of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry

Azcona, Cristina; Burghard, Ellen; Ruza, Elena; Sanchis‐Gimeno, Juan A.; Sierrasesúmaga, Luis

doi:10.1097/00043426-200304000-00006

Cited by 34 publications

(14 citation statements)

References 45 publications

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“…With regard to the question of whether the adverse effects of anti-tumoral treatment on bone metabolism and mineralization are reversible or not, the published data (3,6,31,32) is controversial and inconsistent. In our series, we detected a weak positive correlation between remission time and lumbar BMD but the catch-up is not complete and contributes to the high risk of developing osteoporosis in the future decades of life.…”

Section: Discussionmentioning

confidence: 99%

Bone Mineral Density and Bone Metabolism In Children Treated for Bone Sarcomas

2006

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ABSTRACT:In adolescent bone sarcoma patients, bone mass acquisition is potentially compromised at a time in which it should be at a maximum. To evaluate the problem we measured bone mineral density (BMD) and serum markers of bone formation and resorption in a series of pediatric patients with bone tumors. BMD was measured by dual-energy x-ray absorptiometry, at clinical remission, for lumbar spine and the neck of the femur in 38 osteosarcoma and 25 Ewing's sarcoma patients. Mean age was 20.65 and 19.13 y respectively. Serum markers of bone metabolism were: OC, PICP, ICTP, 25-OH vit D and 1,25-(OH) 2 vit D, IGF-I, IGFBP-3 and intact PTH. Serum was sampled throughout anti-tumoral treatments and followup. We analyzed 85 samples from 59 osteosarcoma patients and 54 samples from 36 Ewing's sarcoma patients. Patients had decreased lumbar and femoral BMD. The decrease was more pronounced in pubertal patients compared with those who had completed pubertal development at the time of disease diagnosis. Multivariate analysis indicated that sex, age, weight and BMI were significant in lumbar BMD depletion. Weight and BMI were significant in femoral BMD depletion. Serum markers of bone formation (PICP and OC) and resorption (ICTP) were, throughout, lower than reference values. Significant alterations in other markers were also observed. Up to a third of osteosarcoma and Ewing's sarcoma patients in clinical remission had some degree of BMD deficit. The corresponding increased risk of pathologic bone fractures constitutes a reduction in future quality of life. B one growth and mineralization begin during fetal development and continue, at different rates, throughout infancy and adolescence until the accrued bone mass peak in the third decade of life (1). During infancy and adolescence two processes are involved in bone mass acquisition: bone neoformation from the growth cartilage (endochondral ossification) and remodeling of previously synthesized bone (2). If an optimal peak bone mass is not attained during adolescence, the risk of osteoporosis and pathologic fractures during adulthood is increased.There are various studies of bone growth and maintenance in child cancer patients but few large series are available (3-5). Best studied have been children treated for acute lymphoblastic leukemia (ALL) who are particularly at risk for bone mineral density (BMD) deficits after cranial irradiation (6 -8). Some pediatric solid tumors have been included in the larger series, which tend to be rather heterogeneous, but there is scant BMD data for pediatric bone sarcomas, osteosarcomas and Ewing's sarcomas (9).Children undergoing anti-tumoral treatments are at risk from several factors that may interfere in bone mass acquisition and maintenance. These factors include: the suboptimal nutritional status, prolonged immobilization, hormonal disorders, hypogonadism and treatments with chemotherapy, radiotherapy and with glucocorticoids. These factors have a strong impact on patients with bone tumors because such tumours are typically diagnose...

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Section: Discussionmentioning

confidence: 99%

Bone Mineral Density and Bone Metabolism In Children Treated for Bone Sarcomas

2006

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“…Osteopenia was first described more than 15 years ago in survivors of osteogenic sarcoma 57 and more recently was reported also in survivors of Ewing sarcoma. 58 The deficit in bone mineral may persist for more than a decade. 59 A similar deficit has been noted in survivors of rhabdomyosarcoma.…”

Section: Bone Mineral Loss and Cancer In Early Lifementioning

confidence: 99%

Osteopenia and cancer in children and adolescents

Sala

Barr

2007

Cancer

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The attainment of a satisfactory peak bone mass, which is accomplished largely by the end of adolescence, is the best protection against excessive bone mineral loss in late adulthood. Factors that influence this process include age, race, sex, body size, pubertal status, diet, physical activity, and other lifestyle elements.Cancer and its treatment in children and teenagers adversely impact bone mineralization. In particular, chemotherapy (especially glucocorticosteroids and methotrexate) and cranial irradiation (apparently by reducing growth hormone secretion and by causing hypogonadotropic hypogonadism) interfere with normal bone turnover. Resorption often exceeds formation, resulting in net bone mineral loss and providing a rational basis for the use of antiresorptive drugs. Such osteopenia may be symptomatic, with pain and abnormal gait, and increases the risk of fractures several fold. The disorder is compounded by reduced physical activity, so programs to reduce this deficit are of measurable benefit. All of those engaged in the care of children and adolescents with cancer have an opportunity to improve the bone health of these young people and to limit their risk of developing osteoporosis and fragility fractures in adult life.

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“…Osteoporosis has usually been considered a disease that affects the elderly, but researchers have proved that it has pediatric origins [15,[18][19]. Lim et al (16) observed that bone tumor survivors diagnosed at a young age showed a higher prevalence of osteoporosis than survivors diagnosed at an older age (37.5% vs. 10.0%).…”

Section: Discussionmentioning

confidence: 99%

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

Ambroszkiewicz¹,

Gajewska²,

Rogowska³

et al. 2015

neo

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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.

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Reduced Bone Mineralization in Adolescent Survivors of Malignant Bone Tumors: Comparison of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry

Cited by 34 publications

References 45 publications

Bone Mineral Density and Bone Metabolism In Children Treated for Bone Sarcomas

Bone Mineral Density and Bone Metabolism In Children Treated for Bone Sarcomas

Osteopenia and cancer in children and adolescents

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

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