Original ArticlesAltered bone mineral density and body composition, and increased fracture risk in childhood acute lymphoblastic leukemia☆
Section snippets
Patients
We studied 61 children (37 boys and 24 girls; median age, 7.1 years; range, 1.6-16.8 years) with ALL, who were referred to the Sophia Children's Hospital, Rotterdam, and treated according to the current national ALL protocol of the Dutch Childhood Leukemia Study group (DCLSG-ALL9). Patients with peripheral white blood cell counts >50 × 109/L, T-cell phenotype and/or mediastinal mass, extramedullary leukemia, patients with t(9;22), 11q23 with MLL gene rearrangements and poor responders to
Anthropometry and body composition
The results of height and body composition are shown in Fig 1.Mean height SDS was −0.19 (SD = 1.14, P =.20) at diagnosis. During treatment height SDS decreased significantly, mainly in the first 32 weeks of
Discussion
We found that children with ALL had reduced BMDLS already at diagnosis, which remained low during treatment, suggesting that the disease itself caused osteopenia. BMDTB was normal at diagnosis, with a fast decrease mainly in the first 32 weeks, in which chemotherapy was most intensive and included high-dose dexamethasone and MTX.
The different results for lumbar spine and total body may be explained by differences in bone composition. Lumbar spine consists mainly of trabecular bone, whereas
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2023, Journal of Bone OncologyCitation Excerpt :Thus, this issue remains to be addressed. An increased risk of fracture has been reported in patients with ALL during treatment and shortly after the completion of treatment [39–41]. However, the incidence of fractures among long-term survivors remains poorly understood.
Bone health in glucocorticoid-treated childhood acute lymphoblastic leukemia
2021, Critical Reviews in Oncology/HematologyCitation Excerpt :Interestingly, the role of genetic alterations in BMD deficits is currently being explored and various single nucleotide polymorphisms (SNPs) have been associated with decreased BMD values in children treated for ALL (Inaba et al., 2018; te Winkel et al., 2010, 2011; Jones et al., 2008; Park et al., 2017). Regarding the occurrence of fractures, elevated incidence has been reported during and after the cessation of therapy, causing severe vertebral malformation and persistent chronic pain (Atkinson et al., 1998; van der Sluis et al., 2002; Mostoufi-Moab et al., 2012; van der Sluis et al., 2000; Holzer et al., 2003; Bilariki et al., 2010; van Beek et al., 2006; Hogler et al., 2007; Alos et al., 2012). Interestingly, lower BMD at diagnosis and during treatment are strong predictors for increased fracture incidence (te Winkel et al., 2014).
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Reprint requests: Inge van der Sluis, MD, PhD, Sophia Children's Hospital, Subdiv Endocrinology, PO Box 2060, 3000 CB Rotterdam, The Netherlands.