Original ArticlesRelationships of Bone Mineral Density to Whole Body Mass, Fat Mass and Fat-free Mass in Long-term Survivors of Acute Lymphoblastic Leukemia in ChildhoodAthale, Uma H. MD, MBBS*,†; Marriott, Christopher J.C. MD‡,§; Cranston, Amy BSc†; McDonald, Paula B.Pharm†; Webber, Colin E. PhD‡,§,✠; Farncombe, Troy H. PhD‡,§; Barr, Ronald D. MD, MBChB*,†Author Information Departments of *Pediatrics §Radiology, McMaster University †McMaster Children’s Hospital ‡Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada ✠Deceased. C.E.B. played a leading role in the study concept, design, and implementation. He died in September 2012. The authors declare no conflict of interest. Reprints: Uma H. Athale, MD, MBBS 3N27D, HSC, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1 (e-mail: [email protected]). Journal of Pediatric Hematology/Oncology: January 2021 - Volume 43 - Issue 1 - p 12-17 doi: 10.1097/MPH.0000000000001863 Buy SDC Metrics Abstract Body size influences bone mineral density (BMD) in health. Relationships of BMD with body mass index, fat mass (FM), fat-free mass, and appendicular lean mass were explored in acute lymphoblastic leukemia (ALL) survivors (n=75; 41 males; 45 standard risk ALL) >10 years from diagnosis. Dual energy radiograph absorptiometry performed body composition analysis. Relationships were assessed by regression analyses and Pearson correlation coefficients (r). Twenty subjects (26.3%) were osteopenic; lumbar spine (LS) BMD Z score <−1.00. Age at diagnosis, sex, ALL risk-category, type of post-induction steroid or cranial radiation did not correlate with LS or whole body (WB) BMD. Body mass index correlated significantly with LS BMD (r=0.333, P=0.004) and WB BMD (r=0.271, P=0.033). FM index (FM/height²) Z score showed no significant correlation with LS or WB BMD. Fat-free mass index Z score correlated strongly with LS BMD (r=0.386, P=0.013) and WB BMD (r=0.605, P<0.001) in males but not in females. The appendicular lean mass index, a surrogate for skeletal muscle mass, correlated significantly with LS BMD (r=0.367, P=0.018) and WB BMD (r=0.604, P<0.001) in males but not in females. Future studies to evaluate interventions to enhance BMD focused on improving body composition particularly skeletal muscle mass are warranted. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.