Bone Abstracts (2015) 4 P193 | DOI: 10.1530/boneabs.4.P193

Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia

MAH den Hoed1,3, SMF Pluijm1,3, HA de Groot-Kruseman2, M Fiocco4, P Hoogerbrugge5, JA Leeuw6, MCA Bruin7, IM van der Sluis1, D Bresters4, MH Lequin1, JC Roos8, AJP Veerman8, R Pieters3 & MM van den Heuvel-Eibrink3


1Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands; 2Dutch Childhood Oncology Group, Hague, The Netherlands; 3Princess Maxima Center, Utrecht, The Netherlands; 4Leiden University Medical Center, Leiden, The Netherlands; 5Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands; 6University of Groningen, Groningen, The Netherlands; 7University Medical Center Utrecht, Utrecht, The Netherlands; 8Vrije Universiteit Medical Center, Amsterdam, The Netherlands.


Objectives: Osteonecrosis (ON) and decline of bone mineral density (BMD) are serious side effects during and after treatment of childhood acute lymphoblastic leukemia (ALL). It is unknown whether ON and low BMD co-occur in the same patients, and whether these two osteogenic side-effects can mutually influence each other’s development.

Methods: BMD and the incidence of symptomatic ON were prospectively assessed in a national cohort of 466 patients with ALL (4–18 years of age) who were treated according to the dexamethasone-based Dutch Child Oncology Group-ALL9 protocol. BMD of the lumbar spine (BMDLS)(n=466) and of the total body (BMDTB)(n=106) were measured by dual x-ray absorptiometry. BMD was expressed as age- and gender-matched standard deviation scores (SDS; z-score). Multivariate linear mixed models were adjusted for age at diagnosis.

Results: Thirty patients (6.4%) suffered from symptomatic ON. At baseline, BMDLS and BMDTB did not differ between patients who developed or who did not develop ON. At cessation of treatment, patients with ON had a lower mean BMDLS and BMDTB than patients without ON (respectively, ON+: −2.16 vs ON−: −1.21, P<0.01 and ON+: −1.73 vs ON−: −0.57, P<0.01). Multivariate analyses showed that patients with ON had a steeper BMDLS and BMDTB decline during follow-up than patients without ON (interaction group time, P=0.09 and P=0.04).

Conclusion: We conclude that symptomatic ON and low BMD during antileukemic treatment co-occur in pediatric ALL patients. BMD status at ALL diagnosis does not seem to precede ON. However, the development of ON seems to aggravate BMD decline during antileukemic treatment, most likely due to bone destruction and the advised physical immobilization.

Disclosure: The authors declared no competing interests.