Original Articles
Altered bone mineral density and body composition, and increased fracture risk in childhood acute lymphoblastic leukemia

https://doi.org/10.1067/mpd.2002.125728Get rights and content

Abstract

Objective: To evaluate fracture rate and bone mineral density (BMD) and body composition in children with acute lymphoblastic leukemia (ALL) treated with dexamethasone-based chemotherapy. Study design: Children with ALL (n = 61) participated. At diagnosis, during therapy, and one year after cessation of therapy, BMD and body composition were measured using dual energy X-ray absorptiometry of lumbar spine (LS) and total body (TB). Serum markers of bone turnover were assessed. Results: BMDLS was significantly reduced at diagnosis, and remained low during therapy. BMDTB was normal at diagnosis, with a fast decrease in the first 32 weeks, in which chemotherapy was relatively intensive. Apparent ("volumetric") BMDLS was also reduced, but this did not reach significance at diagnosis and follow-up. Bone formation markers were reduced at diagnosis; formation as well as resorption markers increased during treatment. Fracture rate was 6 times higher in ALL patients compared with healthy controls. Lean body mass was decreased at baseline. Percentage of body fat increased significantly during therapy. After ALL treatment was completed, BMD and body composition tended to improve. Conclusions: Children with ALL are at risk for osteopenia because of the disease itself and the intensive chemotherapy. Fracture rate increases substantially, not only during but also shortly after treatment. (J Pediatr 2002;141:204-10)

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.

. Body composition and height at diagnosis of ALL, during therapy, and after cessation of therapy. (Mean; error bars represent SEM). *Comparison of the mean with zero P <.05; # Compared with t = 0, P <.05. n/n , Number of LBM and % fat measurements/number of height and BMI measurements.

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

References (0)

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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.

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