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Cross-Sectional Study of Bone Mineral Density in Adult Survivors of Solid Pediatric Cancers

Kelly, Jennifer MD*; Damron, Timothy MD; Grant, William EdD; Anker, Christopher BS; Holdridge, Sean BS; Shaw, Susan MS, PNP§; Horton, Jason BS; Cherrick, Irene MD§; Spadaro, Joseph PhD

Journal of Pediatric Hematology/Oncology: May 2005 - Volume 27 - Issue 5 - p 248-253
doi: 10.1097/01.mph.0000162526.77400.78
Original Article

To investigate the hypothesis that survivors of pediatric solid cancer have low bone mineral density, a cross-sectional study was done of subjects who had received treatment for pediatric solid tumors before 16 years of age and were less than 40 years old at follow-up. Excluded were subjects treated for acute lymphoblastic leukemia or those who had received cranial irradiation, total body radiation, or nonautologous bone marrow transplant. The study group consisted of 38 subjects, with the most common diagnoses being lymphoma (n = 17), sarcoma (n = 8), Wilms tumor (n = 5), and neuroblastoma (n = 4). Median age was 22 years (range 12-32). Time from diagnosis of underlying cancer averaged 12.6 years (range 5.5-20.3). Using criteria of osteopenia (Z-score ≤−1.0 and >−2.0) and osteoporosis (Z-score ≤ −2.0) for any one or more areas including total body, lumbar spine, total hip, or femoral neck density, 13 of the 38 subjects (34%) had osteopenia or osteoporosis. A further six subjects (16%) had isolated upper extremity osteopenia or osteoporosis. Multivariate analysis showed a direct relationship between the number of chemotherapy drugs administered and the presence of osteopenia or osteoporosis in the lower extremities (P = 0.03). Young survivors of childhood solid tumors are at increased risk of developing premature osteopenia or osteoporosis, and screening evaluations and follow-up are warranted.

From the *Department of Endocrinology, Upstate Medical University, Syracuse, New York; †Department of Orthopedics, Upstate Medical University, Syracuse, New York; ‡Department of Family Medicine, Upstate Medical University, Syracuse, New York; and §Department of Pediatric Oncology, Upstate Medical University, Syracuse, New York.

Received for publication March 20, 2004; accepted March 4, 2005.

This study was funded by the Georg Fund of the Syracuse Community Foundation.

Presented at the American Academy of Orthopaedic Surgeons 71st Annual Meeting, San Francisco, CA, March 2004.

Reprints: Timothy A. Damron, Musculoskeletal Science Research Laboratory, Room 3117, Institute for Human Performance, 505 Irving Avenue, Syracuse, NY 13210 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.