Bone Abstracts (2015) 4 P150 | DOI: 10.1530/boneabs.4.P150

Impaired bone mineral density in adult survivors of childhood cancer: a literature review

Saskia Pluijm1,2, Marissa den Hoed2, Sebastian Neggers3, Rob Pieters2 & Marryvan den Heuvel-Eibrink1,2


1ErasmusMC, Department of Paediatric Oncology/Haematology, Rotterdam, The Netherlands; 2Princess Maxima Center for Paediatric Oncology, Utrecht, The Netherlands; 3Department of Internal Medicine, Section of Endocrinology, Rotterdam, The Netherlands.


Objectives: impairment of bone mineral density (BMD) is a complication of childhood cancer treatment. A comprehensive review on the occurrence of impaired BMD in childhood cancer survivors (CCS), and which disease subgroups are at risk has never been pursued so far. The aim of this study was to summarize all knowledge on BMD status and associated determinants in long-term adult childhood cancer survivors (CCS) based on available literature.

Methods: an electronic literature search was performed using PubMed, Medline, Scopus and Web of Science databases. Papers were included if patients were survivors of childhood cancer (median age at diagnosis ≤18 years), were at least a median period of 5 years after cessation of therapy, and had a median age of ≧18 years old at BMD measurement. Outcome measures were total body BMD (BMDTB), lumbar spine BMD (BMDLS) and hip BMD, including BMD of the femoral neck (BMDFN) and total hip (BMDTH).

Results: We found 30 studies including survivors of pediatric acute lymphoblastic leukaemia (ALL) (14 studies), (non)Hodgkins’ lymphoma (HL/NHL), brain tumors, osteosarcoma or all types of cancer. The median age at follow-up ranged from 18.2 to 33.3 years, and median time since diagnosis ranged from 4.8 to 27.7 years. The majority of the studies (18 studies) used univariate statistical analysis to examine possible determinants of BMD. More than half (50–60%) of the studies that assessed the BMDTB, BMDLS, BMDFN and BMDTH found significantly lower BMD values in comparison with healthy peers. Total body BMDTB scores <−1 were reported in 2.8–38%, and lumbar spine BMDLS scores<−1 in 19.3–65% of the survivors. Lowest z-scores were found in osteosarcoma survivors (BMDTB: −1.3 and BMDFN: −1.98). Lower body weight at adult age (DXA) and treatment with cranial radiotherapy, glucocorticosteroids or chemotherapeutic agents during therapy for childhood cancer were most frequently identified as independent determinants.

Conclusion: This review of mainly cross-sectional studies suggest that long-term CCS are prone to BMD impairment, and lower body weight at adult age (DXA) and previous treatment with cranial radiotherapy, glucocorticosteroids or chemotherapeutic agents were most frequently identified as independent determinants. Prospective studies including large representative cohorts of survivors with long-term follow-up are required to accurately assess the occurrence of clinical significant impaired BMD, and its independent determinants in CCS.

Disclosure: The authors declared no competing interests.

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