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Impaired Development of Bone Mineral Density During Chemotherapy: A Prospective Analysis of 46 Children Newly Diagnosed with Cancer
Author(s) -
Arikoski Pekka,
Komulainen Jorma,
Riikonen Pekka,
Parviainen Markku,
Jurvelin Jukka S.,
Voutilainen Raimo,
Kröger Heikki
Publication year - 1999
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1359/jbmr.1999.14.12.2002
Subject(s) - medicine , n terminal telopeptide , bone mineral , osteopenia , bone remodeling , femoral neck , bone resorption , osteoporosis , type i collagen , endocrinology , bone density , dual energy x ray absorptiometry , malignancy , urology , osteocalcin , cancer , chemistry , alkaline phosphatase , biochemistry , enzyme
Osteopenia and osteoporosis are becoming increasingly recognized in children with cancer, though reasons for these changes are poorly understood. The purpose of the present study was to evaluate longitudinal changes in bone mineral density (BMD) and bone turnover in newly diagnosed children with a malignancy. Lumbar spine (L2–L4) and femoral neck bone mineral density (BMD areal , g/cm 2 ) was measured by dual‐energy X‐ray absorptiometry in 46 children (age 2.9–16.0, median 8.0 years; 15 leukemias, 12 lymphomas, 19 solid tumors) at diagnosis, and after 6 months from the baseline. The apparent volumetric bone mineral density (BMD vol ) was calculated to minimize the effect of bone size on BMD. Serum levels of osteocalcin (OC), type I collagen carboxy‐terminal propeptide (PICP), and type I collagen carboxy‐terminal telopeptide (ICTP) were analyzed at diagnosis, and during a 6‐month follow‐up. A significant decrease in lumbar BMD vol (–2.1%, p < 0.05), and in femoral BMD areal (–9.9%, p = 0.0001) and BMD vol (–8.5%, p = 0.0001) was observed after 6 months when compared with baseline measurements. The markers of bone formation (PICP, OC) were significantly decreased, and the marker of bone resorption (ICTP) was significantly increased at diagnosis as compared with normal values. By the end the follow‐up, the levels of PICP and OC were normalized, whereas the level of ICTP continued to increase indicating that there was a negative balance in bone turnover. A deficient accumulation of bone mass might predispose children with a malignancy to impaired development of peak bone mass. A controlled study determining the benefits of an early intervention on bone turnover should be considered in these patients.