Investigating the bone mineral density in children with solid tumors in southern Iran: a case–control study
Along with increasing childhood cancer survival, there is increasing concern about its chronic complications. We showed that 20.5 and 45.9% of children with solid tumors in southern Iran had low bone mass for chronological age in lumbar and femoral area, which was associated with serum ferritin and hemoglobin. 52.4% of these children had vitamin D deficiency, as well.
Along with increasing the childhood cancer survival, there is increasing concern about the chronic complications of the disease and the related therapies. This study aims to compare the vitamin D status and bone mineral apparent density (BMAD) of these children with healthy ones and assess some possible associated factors.
This case–control study enrolled 50 children with solid tumors and their age- and sex-matched controls. Dual-energy X-ray absorptiometry was used to assess bone mineral density. Body mass index, puberty, physical activity, sun exposure, and biochemical data were assessed.
52.4% of children with solid tumors had vitamin D deficiency, and there was no significant difference between the prevalence of vitamin D deficiency in patients and controls (P = 0.285). The prevalence of low bone mass for chronological age in lumbar area was 20.5 and 12.5% in patients and controls, respectively (P = 0.399). Lumbar spine BMD was associated with hemoglobin level (r = 0.468, P = 0.049), while low bone mass in femoral neck was associated with serum ferritin (859 ± 1037 in low bone mass vs. 178 ± 264 in without low bone mass, P = 0.039).
Vitamin D deficiency and low bone mass are prevalent among Iranian children with solid tumors. Future studies are warranted to investigate the best strategies to prevent and treat vitamin D deficiency and low bone mass in children surviving cancer.
KeywordsLow bone mass Children Iran Solid tumors Vitamin D
We would like to thank Ms. R. Farmani for English editing and Ms. Sh. Parand for helping us to prepare the manuscript.
Compliance with ethical standards
Conflict of interest
- 4.Siegel DA, Claridy M, Mertens A, George E, Vangile K, Simoneaux SF, Meacham LR, Wasilewski-Masker K (2017) Risk factors and surveillance for reduced bone mineral density in pediatric cancer survivors. Pediatr Blood Cancer 64(9). https://doi.org/10.1002/pbc.26488
- 7.Kelly J, Damron T, Grant W, Anker C, Holdridge S, Shaw S, Horton J, Cherrick I, Spadaro J (2005) Cross-sectional study of bone mineral density in adult survivors of solid pediatric cancers. J Pediatr Hematol Oncol 27(5):248–253. https://doi.org/10.1097/01.mph.0000162526.77400.78 CrossRefPubMedGoogle Scholar
- 10.Pirker-Fruhauf UM, Friesenbichler J, Urban EC, Obermayer-Pietsch B, Leithner A (2012) Osteoporosis in children and young adults: a late effect after chemotherapy for bone sarcoma. Clin Orthop Relat Res 470(10):2874–2885. https://doi.org/10.1007/s11999-012-2448-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Kremer LC, Mulder RL, Oeffinger KC, Bhatia S, Landier W, Levitt G, Constine LS, Wallace WH, Caron HN, Armenian SH, Skinner R, Hudson MM, International Late Effects of Childhood Cancer Guideline Harmonization Group (2013) A worldwide collaboration to harmonize guidelines for the long-term follow-up of childhood and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Pediatr Blood Cancer 60(4):543–549. https://doi.org/10.1002/pbc.24445 CrossRefPubMedGoogle Scholar
- 15.Saki F, Dabbaghmanesh MH, Omrani GR, Bakhshayeshkaram M (2015) Vitamin D deficiency and its associated risk factors in children and adolescents in southern Iran. Public Health Nutr:1–6Google Scholar
- 16.Bilariki K, Anagnostou E, Masse V, Elie C, Grill J, Valteau-Couanet D, Kalifa C, Doz F, Sainte-Rose C, Zerah M, Mascard E, Mosser F, Ruiz JC, Souberbielle JC, Eladari D, Brugières L, Polak M (2010) Low bone mineral density and high incidences of fractures and vitamin D deficiency in 52 pediatric cancer survivors. Horm Res Paediatr 74(5):319–327. https://doi.org/10.1159/000313378 CrossRefPubMedGoogle Scholar
- 17.Kelly KM, Thornton JC, Hughes D, Osunkwo I, Weiner M, Wang J, Horlick M (2009) Total body bone measurements: a cross-sectional study in children with acute lymphoblastic leukemia during and following completion of therapy. Pediatr Blood Cancer 52(1):33–38. https://doi.org/10.1002/pbc.21760 CrossRefPubMedGoogle Scholar
- 19.Ashouri E, Meimandi EM, Saki F, Dabbaghmanesh MH, Omrani GR, Bakhshayeshkaram M (2015) The impact of LRP5 polymorphism (rs556442) on calcium homeostasis, bone mineral density, and body composition in Iranian children. J Bone Miner Metab 33(6):651–657. https://doi.org/10.1007/s00774-014-0624-4 CrossRefPubMedGoogle Scholar
- 20.Zemel BS, Kalkwarf HJ, Gilsanz V, Lappe JM, Oberfield S, Shepherd JA, Frederick MM, Huang X, Lu M, Mahboubi S, Hangartner T, Winer KK (2011) Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children: results of the bone mineral density in childhood study. J Clin Endocrinol Metab 96(10):3160–3169. https://doi.org/10.1210/jc.2011-1111 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Gordon CM, Bachrach LK, Carpenter TO, Crabtree N, El-Hajj Fuleihan G, Kutilek S et al (2008) Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD Pediatric Official Positions. J Clin Densitom 11(1):43–58. https://doi.org/10.1016/j.jocd.2007.12.005 CrossRefPubMedGoogle Scholar
- 24.Azcona C, Burghard E, Ruza E, Gimeno J, Sierrasesumaga L (2003) Reduced bone mineralization in adolescent survivors of malignant bone tumors: comparison of quantitative ultrasound and dual-energy x-ray absorptiometry. J Pediatr Hematol Oncol 25(4):297–302. https://doi.org/10.1097/00043426-200304000-00006 CrossRefPubMedGoogle Scholar