Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for osteoporosis in long-term survivors of intracranial germ cell tumors

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We measured bone mineral densities in 28 intracranial germ cell tumor long-term survivors. There was the high prevalence of osteoporosis and osteopenia, 25.0% and 42.9%, respectively, and three additional risk factors, male sex, a low lean mass, and adult growth hormone replacement, were identified.

Introduction

Intracranial germ cell tumor long-term survivors (iGCTLS) have many risk factors for osteoporosis, including irradiation from cancer therapy and multiple hormone deficiencies. However, no study of bone mineral density (BMD) has been conducted in iGCTLS because these tumors are rare. The aims of this study were to evaluate the prevalence of osteoporosis and to identify risk factors associated with reduced bone mass in iGCTLS.

Methods

We evaluated BMD and body composition of 28 iGCTLS (10.9 ± 5.2 years after cancer treatment; 13 males) using dual-energy X-ray absorptiometry. To determine risk factors, we analyzed the medical history, including the nature of the tumor, treatment modality, endocrine status, hormone replacement therapy, lifestyle, and biochemical parameters.

Results

Twenty-five percent of iGCTLS were diagnosed with osteoporosis and 42.9% with osteopenia. Most males (92.3%) had low BMD. Lean mass (LM) was positively correlated with BMD in all regions of interest, and the starting age of adult growth hormone (GH) replacement was negatively correlated with the BMD Z-score at the femur neck. In logistic regression analysis, male sex and low LM were related to low BMD.

Conclusions

The iGCTLS had a high prevalence of low BMD. We found that male sex, low LM, and delayed start of adult GH replacement were risk factors for osteoporosis. Therefore, the BMD of all iGCTLS should be evaluated, and if it is low, proper management should be started early.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kaltsas T, Pontikides N, Tsiotsia E et al (2004) Consequences of an intracranial germ cell-tumor in a young adolescent. Pediatr Endocrinol Rev 1:501–504

    PubMed  Google Scholar 

  2. Packer RJ, Cohen BH, Cooney K (2000) Intracranial germ cell tumors. Oncologist 5:312–320

    PubMed  CAS  Google Scholar 

  3. Ho DM, Liu HC (1992) Primary intracranial germ cell tumor. Pathologic study of 51 patients. Cancer 70:1577–1584

    Article  PubMed  CAS  Google Scholar 

  4. Bamberg M, Kortmann RD, Calaminus G et al (1999) Radiation therapy for intracranial germinoma: results of the German cooperative prospective trials MAKEI 83/86/89. J Clin Oncol 17:2585–2592

    PubMed  CAS  Google Scholar 

  5. Buckner JC, Peethambaram PP, Smithson WA et al (1999) Phase II trial of primary chemotherapy followed by reduced-dose radiation for CNS germ cell tumors. J Clin Oncol 17:933–940

    PubMed  CAS  Google Scholar 

  6. Cooper C, Westlake S, Harvey N, Javaid K, Dennison E, Hanson M (2006) Review: developmental origins of osteoporotic fracture. Osteoporos Int 17:337–347

    Article  PubMed  Google Scholar 

  7. Mora S, Gilsanz V (2003) Establishment of peak bone mass. Endocrinol Metab Clin North Am 32:39–63

    Article  PubMed  Google Scholar 

  8. Heaney RP, Abrams S, Dawson-Hughes B et al (2000) Peak bone mass. Osteoporos Int 11:985–1009

    Article  PubMed  CAS  Google Scholar 

  9. Gurney JG, Kadan-Lottick NS, Packer RJ et al (2003) Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood Cancer Survivor Study. Cancer 97:663–673

    Article  PubMed  Google Scholar 

  10. Barr RD, Simpson T, Webber CE et al (1998) Osteopenia in children surviving brain tumours. Eur J Cancer 34:873–877

    Article  PubMed  CAS  Google Scholar 

  11. Sala A, Pencharz P, Barr RD (2004) Children, cancer, and nutrition—–a dynamic triangle in review. Cancer 100:677–687

    Article  PubMed  Google Scholar 

  12. Gilsanz V, Carlson ME, Roe TF, Ortega JA (1990) Osteoporosis after cranial irradiation for acute lymphoblastic leukemia. J Pediatr 117:238–244

    Article  PubMed  CAS  Google Scholar 

  13. Petraroli M, D'Alessio E, Ausili E (2007) Bone mineral density in survivors of childhood brain tumours. Child Nerv Syst 23:59–65

    Article  CAS  Google Scholar 

  14. Carroll PV, Christ ER, Bengtsson BA et al (1998) Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee. J Clin Endocrinol Metab 83:382–395

    Article  PubMed  CAS  Google Scholar 

  15. Children's Oncology Group (2007) Establishing and enhancing services for childhood cancer survivors: long-term follow-up program resource guide. Available at http://www.survivorshipguidelines.org/

  16. Lim JS, Hwang JS, Cheon GJ et al (2009) Gender differences in total and regional body composition changes as measured by dual-energy X-ray absorptiometry in Korean children and adolescents. J Clin Densitom 12:229–237

    Article  PubMed  Google Scholar 

  17. Lewiecki EM, Gordon CM, Baim S et al (2008) International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone 43:1115–1121

    Article  PubMed  Google Scholar 

  18. Lim JS, Hwang JS, Lee JA et al (2010) Bone mineral density according to age, bone age, and pubertal stages in Korean children and adolescents. J Clin Densitom 13:68–76

    Article  PubMed  Google Scholar 

  19. Tillmann V, Darlington AS, Eiser C, Bishop NJ, Davies HA (2002) Male sex and low physical activity are associated with reduced spine bone mineral density in survivors of childhood acute lymphoblastic leukemia. J Bone Miner Res 17:1073–1080

    Article  PubMed  CAS  Google Scholar 

  20. Pietila S, Sievanen H, Ala-Houhala M, Koivisto AM, Liisa Lenko H, Makipernaa A (2006) Bone mineral density is reduced in brain tumour patients treated in childhood. Acta Paediatr 95:1291–1297

    Article  PubMed  Google Scholar 

  21. Odame I, Duckworth J, Talsma D et al (2006) Osteopenia, physical activity and health-related quality of life in survivors of brain tumors treated in childhood. Pediatr Blood Cancer 46:357–362

    Article  PubMed  Google Scholar 

  22. Banfi A, Bianchi G, Galotto M, Cancedda R, Quarto R (2001) Bone marrow stromal damage after chemo/radiotherapy: occurrence, consequences and possibilities of treatment. Leuk Lymphoma 42:863–870

    Article  PubMed  CAS  Google Scholar 

  23. Wagner LM, Neel MD, Pappo AS et al (2001) Fractures in pediatric Ewing sarcoma. J Pediatr Hematol Oncol 23:568–571

    Article  PubMed  CAS  Google Scholar 

  24. Paulino AC (2004) Late effects of radiotherapy for pediatric extremity sarcomas. Int J Radiat Oncol Biol Phys 60:265–274

    Article  PubMed  Google Scholar 

  25. Meacham L (2003) Endocrine late effects of childhood cancer therapy. Curr Probl Pediatr Adolesc Health Care 33:217–242

    Article  PubMed  Google Scholar 

  26. Lackner H, Benesch M, Schagerl S, Kerbl R, Schwinger W, Urban C (2000) Prospective evaluation of late effects after childhood cancer therapy with a follow-up over 9 years. Eur J Pediatr 159:750–758

    Article  PubMed  CAS  Google Scholar 

  27. Benesch M, Lackner H, Schagerl S, Gallistl S, Frey EM, Urban C (2001) Tumor- and treatment-related side effects after multimodal therapy of childhood intracranial germ cell tumors. Acta Paediatr 90:264–270

    Article  PubMed  CAS  Google Scholar 

  28. Muller HL, Schneider P, Bueb K et al (2003) Volumetric bone mineral density in patients with childhood craniopharyngioma. Exp Clin Endocrinol Diabetes 111:168–173

    Article  PubMed  CAS  Google Scholar 

  29. Loomba-Albrecht LA, Styne DM (2009) Effect of puberty on body composition. Curr Opin Endocrinol Diabetes Obes 16:10–15

    Article  PubMed  CAS  Google Scholar 

  30. Garnett SP, Hogler W, Blades B et al (2004) Relation between hormones and body composition, including bone, in prepubertal children. Am J Clin Nutr 80:966–972

    PubMed  CAS  Google Scholar 

  31. Muszynska-Roslan K, Konstantynowicz J, Krawczuk-Rybak M, Protas P (2007) Body composition and bone mass in survivors of childhood cancer. Pediatr Blood Cancer 48:200–204

    Article  PubMed  Google Scholar 

  32. Koskelo EK, Saarinen UM, Siimes MA (1990) Skeletal muscle wasting and protein-energy malnutrition in children with a newly diagnosed acute leukemia. Cancer 66:373–376

    Article  PubMed  CAS  Google Scholar 

  33. Saggese G, Baroncelli GI, Bertelloni S, Cinquanta L, Di Nero G (1993) Effects of long-term treatment with growth hormone on bone and mineral metabolism in children with growth hormone deficiency. J Pediatr 122:37–45

    Article  PubMed  CAS  Google Scholar 

  34. van der Sluis IM, Boot AM, Hop WC, De Rijke YB, Krenning EP, de Muinck Keizer-Schrama SM (2002) Long-term effects of growth hormone therapy on bone mineral density, body composition, and serum lipid levels in growth hormone deficient children: a 6-year follow-up study. Horm Res 58:207–214

    Article  PubMed  Google Scholar 

  35. Baroncelli GI, Bertelloni S, Sodini F, Saggese G (2004) Longitudinal changes of lumbar bone mineral density (BMD) in patients with GH deficiency after discontinuation of treatment at final height; timing and peak values for lumbar BMD. Clin Endocrinol Oxf 60:175–184

    Article  PubMed  Google Scholar 

  36. Leonard MB, Propert KJ, Zemel BS, Stallings VA, Feldman HI (1999) Discrepancies in pediatric bone mineral density reference data: potential for misdiagnosis of osteopenia. J Pediatr 135:182–188

    Article  PubMed  CAS  Google Scholar 

  37. Webber CE, Sala A, Barr RD (2009) Accounting for body size deviations when reporting bone mineral density variables in children. Osteoporos Int 20:113–121

    Article  PubMed  CAS  Google Scholar 

  38. Korea Centers for Disease Control and Prevention (2007) 2007 Korean national growth charts. Available at http://www.cdc.go.kr

  39. Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27:585–590

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to express their gratitude to all the volunteers. This study was supported by the Pediatric Research Fund of Seoul National University Hospital (grant no. 50240-2010). We also thank the 21-year-old female iGCT patient who inspired us to conduct this study after longitudinal follow-up of BMD for 6 years.

Conflicts of interest

The authors declare that they have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might be considered to represent a conflict of interest in connection with this study.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Seoul National University College of Medicine, Seoul, 110-744, South Korea

    M. J. Kang, S. M. Kim, Y. A. Lee, C. H. Shin & S. W. Yang

  2. Department of Pediatrics, Korea Cancer Center Hospital, 215 Gongneungdong, Nowon-gu, Seoul, 139-706, South Korea

    J. S. Lim

Authors
  1. M. J. Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. M. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. A. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. H. Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. W. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. S. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. S. Lim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kang, M.J., Kim, S.M., Lee, Y.A. et al. Risk factors for osteoporosis in long-term survivors of intracranial germ cell tumors. Osteoporos Int 23, 1921–1929 (2012). https://doi.org/10.1007/s00198-011-1821-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-011-1821-9

Keywords

Search

Navigation