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Archives of Osteoporosis

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01-12-2021 | Radiotherapy | Original Article

A long-term trajectory of bone mineral density in childhood cancer survivors after discontinuation of treatment: retrospective cohort study

Authors: Eryk Latoch, Jerzy Konstantynowicz, Maryna Krawczuk-Rybak, Anna Panasiuk, Katarzyna Muszyńska-Rosłan

Published in: Archives of Osteoporosis | Issue 1/2021

Abstract

Summary

Low bone mineral density (BMD) was diagnosed in 24% of childhood cancer survivors (CCS), whereas very low BMD was relatively uncommon at 8%. We suggest that low BMD in CCS may become alleviated over time. Stem cell transplantation, radiotherapy, and underweight were the strongest independent predictors of decreased BMD.

Purpose

Childhood cancer survivors (CCS) are at risk of premature bone loss, although published studies are inconsistent. The objective of this study was to evaluate the prevalence and pattern of low bone mineral density (BMD) in short- and long-term CCS, and to determine clinical factors affecting skeleton after anticancer treatment.

Methods

This retrospective study was conducted in a cohort of 326 children and young adult CCS (147 females) who completed anticancer treatment. BMD was determined by dual-energy X-ray absorptiometry (DXA). Low BMD was defined as a Z-score ≤ − 1.0, and the very low BMD as a Z-score ≤ − 2.0. Additionally, the changes in BMD over time were studied in 123 CCS who had been re-examined by DXA during follow-up.

Results

Median age at diagnosis was 7.27 years (range, 4.4–10.6); median time between end of treatment and DXA was 6.12 (range, 4.0–22.0). Low BMD was found in 24% of CCS, while very low BMD was relatively uncommon (8%). Based on multivariate analysis, the following were significantly associated with low BMD at the follow-up: hematopoietic stem cell transplantation (OR 3.13, 95% CI 1.02–9.63), head and neck radiotherapy (OR 2.54, 95% CI 1.32–4.90), and body weight below the standard reference (OR 3.57, 95% CI 1.24–10.23). The time-related trajectory showed an improvement (BMD_LS) or stabilization (BMD_TB) in Z-scores values.

Conclusion

These data based on serial DXA measurements, encompassing a long-lasting observation period, show that CCS may not be at risk of premature bone loss in young adulthood. However, it is unknown how the scenario for skeletal mass is until the CCS will achieve older or postmenopausal age.

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Title: A long-term trajectory of bone mineral density in childhood cancer survivors after discontinuation of treatment: retrospective cohort study
Authors: Eryk Latoch
Jerzy Konstantynowicz
Maryna Krawczuk-Rybak
Anna Panasiuk
Katarzyna Muszyńska-Rosłan
Publication date: 01-12-2021
Publisher: Springer London
Keywords: Radiotherapy
Stem Cell Transplantation
Stem Cell Transplantion
Stem Cell Transplantation
Published in: Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-020-00863-9

At a glance: The STEP trials

Springer Medicine

A long-term trajectory of bone mineral density in childhood cancer survivors after discontinuation of treatment: retrospective cohort study

Abstract

Summary

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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