Modifiable risk factors associated with bone deficits in childhood cancer survivors.

Lynda E Polgreen,Alan R Sinaiko,Lyn M Steffen,Donald R Dengel,Joanna L Perkins,Anna Petryk,Julia Steinberger,Andrew C Dietz,Pam Goodman,K Scott Baker,Wendy Leisenring

doi:10.1186/1471-2431-12-40

Abstract

BackgroundTo determine the prevalence and severity of bone deficits in a cohort of childhood cancer survivors (CCS) compared to a healthy sibling control group, and the modifiable factors associated with bone deficits in CCS.MethodsCross-sectional study of bone health in 319 CCS and 208 healthy sibling controls. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). Generalized estimating equations were used to compare measures between CCS and controls. Among CCS, multivariable logistic regression was used to evaluate odds ratios for BMD Z-score ≤ -1.ResultsAll subjects were younger than 18 years of age. Average time since treatment was 10.1 years (range 4.3 - 17.8 years). CCS were 3.3 times more likely to have whole body BMD Z-score ≤ -1 than controls (95% CI: 1.4-7.8; p = 0.007) and 1.7 times more likely to have lumbar spine BMD Z-score ≤ -1 than controls (95% CI: 1.0-2.7; p = 0.03). Among CCS, hypogonadism, lower lean body mass, higher daily television/computer screen time, lower physical activity, and higher inflammatory marker IL-6, increased the odds of having a BMD Z-score ≤ -1.ConclusionsCCS, less than 18 years of age, have bone deficits compared to a healthy control group. Sedentary lifestyle and inflammation may play a role in bone deficits in CCS. Counseling CCS and their caretakers on decreasing television/computer screen time and increasing activity may improve bone health.

Highlights

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, resulting in an increased susceptibility to fracture [1]
cancer survivors (CCS) were slightly older than controls, pubertal Tanner stage was similar between groups
We have no longitudinal data, we found no cross-sectional evidence to suggest “catch-up” in bone mineral density (BMD) for participants treated at a younger, pre-pubertal, age (< 10 years) and confirmed that hypogonadism is associated with bone deficits in CCS

Summary

Introduction

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, resulting in an increased susceptibility to fracture [1]. Reduced bone mineral density (BMD) is a recognized condition among childhood cancer survivors (CCS). It is estimated that up to 46% of CCS less than 18 years old have reduced BMD [2,3,4,5,6,7,8]. The majority of bone accretion occurs in adolescence and young adulthood with peak bone mass reached by the second or third decade [11]. A resultant decrease in peak bone mass would be. To determine the prevalence and severity of bone deficits in a cohort of childhood cancer survivors (CCS) compared to a healthy sibling control group, and the modifiable factors associated with bone deficits in CCS

Methods

Results

Discussion

Conclusion