Bone Abstracts (2013) 2 OC17 | DOI: 10.1530/boneabs.2.OC17

Determinants of bone mineral density in long-term adult survivors of childhood cancer

B C Klap, M L te Winkel, M den Hoed, M van Waas, S J C M M Neggers, A M Boot, R Pieters, S M F Pluijm & M M van den Heuvel-Eibrink


Erasmus MC, Rotterdam, The Netherlands.


Objectives: Osteopenia is a complication of childhood cancer treatment but it is unknown to which extend this occurs in adult survivors, and which subgroups are at risk. We examined bone mineral density (BMD) and assed the relative importance of potential determinants of low BMD in very long-term adult survivors of childhood cancer.

Methods: The single-center cohort study included 410 adult CCSs (median age at diagnosis: 6.6 years (range: 0–17 years) with a median follow-up time of 15.2 years (range 5–39 years). Total body BMD (BMDTB) and BMD of the lumbar spine (BMDLS) were measured with dual X-ray absorptiometry (DXA). In a subsample of 188 survivors, a sequential DXA scan was performed (median time after first DXA: 3.2 years).

Results: Survivors had a lower BMDTB (median standardised difference score (SDS): −0.60; P<0.001) and BMDLS (SDS: −0.40; P<0.001) as compared to healthy peers. In the subsample, BMDTB and BMDLS significantly increased between the first and second DXA (mean SDS: BMDTB=0.08; P=0.003; BMDLS: 0.06; P=0.03). We identified higher age (st. β=−0.17), having had a brain tumor (st. β=−0.20) or sarcoma (st. β=−0.13), cranial (st. β=−0.23) or total body irradiation (st. β=−0.16), use of glucocorticoids (GC) during treatment (st. β−0.22), and lower BMI at follow-up (st. β=0.53) as important determinants of low BMDTB. BMDLS was only associated with BMI (st. β=0.22) and use of cyclophosphamide (st. β=−0.18).

Conclusions: Long-term childhood cancer survivors have a lower BMDTB and BMDLS as compared to healthy peers, but improvement in BMD may still occur. Furthermore, we showed that patients who have had a brain tumor or sarcoma, those who were irradiated, who were treated with glucocorticoids and who have low BMI, are at risk of osteopenia.

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