Osteopenia in young adult survivors of childhood cancer

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Abstract
Background Improved survival of children with malignant diseases is in part due to the application of intensive, multimodality therapies, including radiotherapy, surgery, glucocorticoids, and cytotoxic agents. Such interventions have the potential to induce complex hormonal, metabolic and nutritional effects that may interfere with skeletal mass acquisition during childhood and adolescence: it is possible that such childhood cancer survivors may therefore reach adulthood with diminished peak bone mass and be at increased risk for clinically significant osteoporosis later in their life. Procedure A bone mineral density (BMD) was measured in 26 unselected former cancer patients attending the Pediatric Long‐Term Clinic at M.D. Anderson Cancer Center. BMD was measured at the lumbar spine and the hip using dual X‐ray absorptiometry (Hologic QDR‐4500W). In addition, the patients' complete medical records were reviewed with particular attention to disease type, age modalities of treatment, and hormonal residual deficiencies. Results The median age of patients at the time of cancer diagnosis was 8 years (range, 0.3 to 16 years). Median age at BMD determination was 23 years (range, 18 to 41 years), and the median interval since cancer diagnosis and BMD was 18 years (range, 5 to 29). Overall, their BMD was decreased relative to peak bone mass at all sites: osteopenia was especially pronounced in patients with a history of cranial irradiation who had developed evidence of pituitary insufficiency during childhood or adolescence. Overall, the median BMD T‐score was −1.41 at the lumbar spine, −1.04 at the femoral neck, and −1.06 for total hip. For patients with prior cranial irradiation, T‐score at the lumbar spine was −2.18 (range, −4.06 to −0.98), at the femoral neck −1.92 (range, −4.11 to +1.10), and for total hip −1.67 (range, −4.79 to +0.56); BMD for irradiated patients was significantly lower than BMD of patients without cranial irradiation. We could not discern an independent impact of other disease characteristics or treatment modalities in this small group of patients. Conclusions Osteopenia is a prominent finding in young adults who are survivors of childhood cancers; it is likely that antineoplastic treatments during childhood and adolescence impede peak bone mass acquisition. We suggest that systematic attention to this potential complication is needed in order to identify what subgroups of children may require regular surveillance and what interventions are required for its prevention or treatment. Med. Pediatr. Oncol. 32:272–278, 1999.