Osteopenia in survivors of childhood cancer.

Abstract

9089 Background: As childhood cancer rates continue to improve, long-term complications of therapy are becoming increasingly important. One complication of childhood cancer therapy is osteopenia. This may be due to the cancer itself or treatment related factors such as radiation therapy, specific chemotherapy drugs, and/or the use of steroids. Methods: Recently dual energy X-ray absorptiometry (DXA) scans have become a standard of care for patients at risk for osteopenia attending our long term follow-up clinic. Patients at risk included those with a history of leukemia, lymphoma, and CNS tumors. These patients had prolonged steroid exposure, specific radiation exposures (including total body), endocrinopathies, and/or intensive chemotherapy treatments. A retrospective review of medical records was performed. All patients in the clinic were diagnosed under the age of 21 and were at least 5 years out from diagnosis. Z score for age and gender were obtained from DXA. Patients were compared based on cancer diagnosis. Results: 207 survivors (98 female) had a DXA scan performed. Average age at cancer diagnosis was 7 years (0.5-19y) with DXA performed an average of 11 years (0-34y) after diagnosis. Leukemias (n=119, lymphoblastic leukemias (ALL); n=21, myeloid leukemias) and lymphomas (n=27, Hodgkin; n=20, NHL) were the most common diagnoses. Overall, nearly 19% of survivors (n=39) had Z-score below -1.0 with 7.7% (n=16) below -2.0. No significant differences were seen between males and females in terms of % with Z-score below -1.0 (16.7% vs. 21.2%) or below -2.0 (6.5% vs. 9.1%). Nearly 16% of ALL survivors had a Z-score under -1.0. Patients with ALL accounted for 50% (n=8) of Z-scores below -2, while patients with CNS tumors accounted for 25% (n=4) of this group. The distribution of Z-scores differed significantly across diagnostic groups (p=0.0025). Conclusions: A significant portion of survivors considered to be at risk for osteopenia were indeed found to have low Z-scores measured by DXA scans. This risk varied by diagnosis. Males and females appear to be equally affected. Early interventions such as an exercise program and dietary supplements may be warranted to prevent osteopenia in cancer survivors. No significant financial relationships to disclose.