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Bone mineral density after childhood cancer in 346 long-term adult survivors of childhood cancer

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Abstract

Summary

More than 45 % of long-term childhood cancer survivors (CCS) were diagnosed with osteopenia. Our data suggest that greater awareness for osteopenia is warranted in long-term CCS, especially in survivors who are older than 30 years, male, and underweight and were treated with cranial-spinal radiotherapy and/or steroids.

Introduction

Osteopenia is a potential complication of childhood cancer treatment, but the magnitude of this problem in survivors is unknown. We examined (determinants of) bone mineral density (BMD) status in long-term survivors of adult childhood cancer.

Methods

This retrospective single-centre cohort study included 346 subjects with the most common types of childhood cancer. Subjects had a median age at diagnosis of 7.0 years (range 0.1–16.8 years), a median age at follow-up of 24.5 years (range 18.0–47.6 years) and a median follow-up time of 16.7 years (range 5.6–39.9 years). Total body BMD (BMDTB) and BMD of the lumbar spine (BMDLS) were measured by dual X-ray absorptiometry. Osteopenia was defined as BMD standardized deviation score (SDS) below −1.

Results

Survivors had a lower BMDTB and BMDLS (mean SDS −0.55; p < 0.001 and −0.30; p < 0.001, respectively) as compared to healthy peers. Osteopenia (BMDTB and/or BMDLS) was present in 45 % of the survivors. Multivariate logistic regression analyses identified age at diagnosis <12 years, age >30 years at follow-up, male gender, underweight at follow-up and treatment with cranial-spinal radiotherapy or prednisone as independent prognostic factors for osteopenia.

Conclusions

This large cohort of childhood cancer survivors identified osteopenia in 45 % of CCS. This indicates that greater awareness is warranted, especially in survivors who are older than 30 years, male, have underweight and were treated with cranial-spinal radiotherapy and/or steroids.

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Acknowledgments

MvW, MtW and SN were supported by grants from the Foundation Kinderenkankervrij (KIKA) and WvD is supported by the Paediatric Oncology Centre Society for Research (KOCR), Rotterdam, The Netherlands.

Ethical standards

This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Paediatric Oncology/Haematology, Erasmus University Medical Center (Erasmus MC)-Sophia Children’s Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands

    M. A. H. den Hoed, B. C. Klap, M. L. te Winkel, M. van Waas, S. J. C. M. M. Neggers, K. Blijdorp, W. van Dorp, S. M. F. Pluijm & M. M. van den Heuvel-Eibrink

  2. Princess Maxima Center for Paediatric Oncology, Utrecht, The Netherlands

    R. Pieters

  3. Department of Internal Medicine, Section Endocrinology, Erasmus University Medical Center (Erasmus MC), Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands

    S. J. C. M. M. Neggers & K. Blijdorp

  4. Department of Paediatric Endocrinology, University Medical Centre Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    A. M. Boot

  5. Department of Gynaecology, Erasmus University Medical Center (Erasmus MC), Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands

    W. van Dorp

Authors
  1. M. A. H. den Hoed
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  2. B. C. Klap
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  3. M. L. te Winkel
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  4. R. Pieters
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  5. M. van Waas
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  6. S. J. C. M. M. Neggers
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  7. A. M. Boot
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  8. K. Blijdorp
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  9. W. van Dorp
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  10. S. M. F. Pluijm
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  11. M. M. van den Heuvel-Eibrink
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Corresponding author

Correspondence to M. M. van den Heuvel-Eibrink.

Additional information

M.A.H. den Hoed and B.C. Klap shared first authorship and S.M.F. Pluijm and M.M. van den Heuvel-Eibrink shared last authorship.

Electronic supplementary material

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Supplemental table 1

Body height and bone mineral density in 346 adult long term childhood cancer survivors (DOCX 37 kb)

Supplemental table 2

Bone mineral density adjusted for height SDS in 298 adult long term childhood cancer survivors (DOCX 36 kb)

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den Hoed, M.A.H., Klap, B.C., te Winkel, M.L. et al. Bone mineral density after childhood cancer in 346 long-term adult survivors of childhood cancer. Osteoporos Int 26, 521–529 (2015). https://doi.org/10.1007/s00198-014-2878-z

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