Reduced Bone Mineral Density in Long-term Survivors of Childhood Acute Lymphoblastic Leukemia

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Abstract
Osteoporosis and pathologic fractures are occasionally found in patients with childhood acute lymphoblastic leukemia (ALL). This study was performed to determine the degree of possible osteopenia in long-term survivors of childhood ALL. Lumbar spine (L2-L4) and femoral neck bone mineral densities (BMDs) (g/cm2) were measured in 29 survivors (aged 12 to 30 years, median 17) of childhood ALL 2 to 20 (median 8) years after discontinuation of chemotherapy. These results were compared with those from 273 healthy controls and expressed as a percentage of the age- and sex-matched control values (mean ± standard deviation). Lumbar and femoral BMDs were significantly reduced in survivors of childhood ALL. Particularly, male gender (lumbar: 91.7 ± 10.4%, p = 0.008; femoral: 91.9 ± 11.3%, p = 0.005) and a history of cranial irradiation (lumbar: 93.0 ± 8.9%, p = 0.005; femoral: 94.4 ± 13.3%, p = 0.03) were associated with low lumbar and femoral BMDs. The detected deficit in bone density in survivors of childhood ALL may predispose these patients to osteoporotic fractures later in adulthood. A follow-up of BMD in survivors of childhood ALL should facilitate the identification of patients who would require specific therapeutic interventions to prevent further decrease of their skeletal mass and preserve their BMD.