Risk factors and surveillance for reduced bone mineral density in pediatric cancer survivors

Siegel, David A.; Claridy, Mechelle D.; Mertens, Ann C.; George, Elizabeth; Vangile, Kristen; Simoneaux, Stephen F.; Meacham, Lillian R.; Wasilewski‐Masker, Karen

doi:10.1002/pbc.26488

Cited by 19 publications

(20 citation statements)

References 52 publications

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“…In CCS treated with cranial irradiation, we found lower BMD at the total hip and lumbar spine, which is in line with previous studies [7,8,26]. Cranial irradiation in children is a known risk factor for later pituitary malfunctions [31], among others, growth hormone deficiency (GHD) and hypogonadism.…”

Section: Discussionsupporting

confidence: 91%

“…Among adult childhood cancer survivors (CCS), almost 40% in the large St Jude Lifetime Cohort Study had low BMD in total body or lumbar spine [5]. Hypogonadism has been stated to be a risk factor of low BMD in CCS [6][7][8]. Available studies reporting on the association between hypogonadism and BMD in CCS are based on a low number of subjects [9][10][11], mixing both male and female CCS [8,[10][11][12] or lacking controls [8,9,11], making conclusions regarding possible association between hypogonadism and BMD in adult male CCS difficult.…”

Section: Introductionmentioning

confidence: 99%

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Low bone mineral density is associated with hypogonadism and cranial irradiation in male childhood cancer survivors

et al. 2020

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We investigated if bone mineral density was related to testosterone deficiency and/or previous cancer treatment in men who were childhood cancer survivors. Men with untreated testosterone deficiency or previous treatment with cranial irradiation were at increased risk of impaired bone health. Prevention of osteoporosis should be considered in their follow-up. Introduction Childhood cancer survivors (CCS) are at increased risk of hypogonadism. Reduced bone mineral density (BMD) has been reported in CCS but it is unclear whether this is due to hypogonadism or a direct effect of cancer therapy. This study investigated BMD in CCS, and association with hypogonadism, previous treatment and cancer type. Methods Investigation of 125 CCS (median age 33.7 at inclusion; 9.6 at diagnosis) and 125 age-matched population controls. Serum testosterone and luteinizing hormone were assayed and BMD at total hip and lumbar spine L1-L4 measured. The mean difference in BMD (g/cm 2 ; 95% CI) between CCS and controls was analysed. Odds ratios (OR; 95% CI) for low BMD were also calculated. Results Overall, BMD in the CCS cohort did not significantly differ from controls. However, compared with eugonadal CCS, the CCS with untreated hypogonadism had lower BMD at the hip (mean difference − 0.139 (− 0.210; − 0.067); p < 0.001) and spine (− 0.102 (− 0.174; − 0.030); p = 0.006). They also had a higher risk of low hip BMD (OR 4.1 (1.3; 14); p = 0.018). CCS treated with cranial irradiation also had lower BMD (hip − 0.076 (− 0.133; − 0.019); p = 0.009; spine − 0.071 (− 0.124; − 0.018); p = 0.009) compared with controls. The latter associations remained statistically significant after adjustment for hypogonadism. Conclusions CCS with hypogonadism or previously treated with cranial irradiation are at increased risk of impaired bone health. Prevention of osteoporosis should be considered as an important part in future follow-up of these men.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Low bone mineral density is associated with hypogonadism and cranial irradiation in male childhood cancer survivors

et al. 2020

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“…It is suggested that methotrexate lowers BMD but does not present a significant risk for z-score ≤-2. 25) Hematopoietic stem cell transplantation (HSCT) also affects BMD. Bone loss occurred and continued frequently in the first year following allogeneic HSCT.…”

Section: Causative Factors Of Low Bmd In Children and Adolescents Witmentioning

confidence: 99%

Low bone mineral density in children and adolescents with cancer

Jin

Lee

2020

Ann Pediatr Endocrinol Metab

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Maximizing accumulation of bone mass during childhood and adolescence is essential to attaining optimal peak bone mass. Childhood cancer survivors (CCS) have lower bone mineral density (BMD) than the general population. Chemotherapeutic agents including steroids and radiotherapy can affect BMD. Cancer itself, hormonal insufficiency, a poor nutritional state, and a deficit of physical activities during or after treatment also influence BMD in CCS, resulting in failure to achieve appropriate peak bone mass. Low BMD in childhood and adolescence can lead to osteoporosis in adult life and complications such as bone pain, bone deformity, and fractures. Thus, BMD in CCS should be monitored with appropriate intervention. Adequate intake of calcium and vitamin D and an increase in physical activity are recommended. Timely supplements of hormones are needed in some cases. Some publications have reported that bisphosphonate therapies using pamidronate or alendronate were well tolerated in CCS and helped increase BMD.

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“…Decreased BMD is a well‐known complication following cancer therapy and HSCT . Despite well‐documented decreases in BMD and diminished bone health in HSCT patients, it is unclear whether a significant increase in overall fracture risk ensues . However, vertebral fractures are becoming increasingly recognized, and these underappreciated fractures may be significantly related to decreased BMD …”

Section: Late Effects On the Vertebrae And Bmdmentioning

confidence: 99%

“…[44][45][46] Despite well-documented decreases in BMD and diminished bone health in HSCT patients, 41,[44][45][46] it is unclear whether a significant increase in overall fracture risk ensues. 44,45 However, vertebral fractures are becoming increasingly recognized, and these underappreciated fractures may be significantly related to decreased BMD. 27,47 Vertebral endplate deformity and compression fractures in HSCT and TBI patients may be more common than previously appreciated.…”

Section: Introduction and Epidemiologymentioning

confidence: 99%

Musculoskeletal complications following total body irradiation in hematopoietic stem cell transplant patients

Jackson

Mostoufi‐Moab

Hill‐Kayser

et al. 2017

Pediatric Blood & Cancer

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Total body irradiation (TBI) is commonly used in conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) to treat benign and malignant disease. Though life-saving, these therapies place patients at risk for important side effects, including musculoskeletal complications such as short stature, osteonecrosis, slipped capital femoral epiphysis, and the development of benign and malignant bone tumors. With an increasing number of HSCT survivors, there is a growing need for awareness of the musculoskeletal complications of HSCT and TBI.

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Risk factors and surveillance for reduced bone mineral density in pediatric cancer survivors

Cited by 19 publications

References 52 publications

Low bone mineral density is associated with hypogonadism and cranial irradiation in male childhood cancer survivors

Low bone mineral density is associated with hypogonadism and cranial irradiation in male childhood cancer survivors

Low bone mineral density in children and adolescents with cancer

Musculoskeletal complications following total body irradiation in hematopoietic stem cell transplant patients

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