This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Arikoski, P. Articles by Kröger, H. Search for Related Content PubMed PubMed Citation Articles by Arikoski, P. Articles by Kröger, H.

Alterations in Bone Turnover and Impaired Development of Bone Mineral Density in Newly Diagnosed Children with Cancer: A 1-Year Prospective Study

Departments of Pediatrics and Surgery (H.K.), Kuopio University Hospital, FIN-70211 Kuopio; and the Department of Pediatrics, Tampere University Hospital (M.K.), FIN-33101 Tampere, Finland

Address all correspondence and requests for reprints to: Pekka Arikoski, M.D., Department of Pediatrics, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. E-mail: arikoski{at}messi.uku.fi

In the present study, longitudinal changes in bone mineral density, bone turnover, and bone hormonal metabolism were evaluated in newly diagnosed children with cancer. Lumbar spine (L2–L4) and femoral neck bone mineral densities (grams per cm²) were measured by dual energy x-ray absorptiometry in 28 children (age, 2.9–16.0 yr; median, 8.0 yr; 10 acute lymphoblastic leukemias, 18 solid tumors) at diagnosis and after a 1-yr follow-up. Apparent volumetric density (grams per cm³) was calculated to minimize the effect of bone size on BMD. Serum levels of osteocalcin (OC), type I collagen carboxyl-terminal propeptide (PICP), and type I collagen carboxyl-terminal telopeptide were measured serially during the study. Serum 25- hydroxyvitamin D, 1,25-dihydroxyvitamin D, insulin-like growth factor I (IGF-I), and IGF-binding protein-3 were analyzed at diagnosis and at 1-yr follow-up.

A significant decrease in femoral bone mineral density and apparent volumetric density was observed during the year after diagnosis [(mean (SD), -10.1% (8.8%) and -11.3% (8.1%) respectively; P < 0.01], whereas age- and sex-matched controls showed annual increments of +5.4% (7.7%; P < 0.01) and +0.7% (5.7%; P = NS) respectively. The markers of bone formation (PICP and OC) were significantly decreased at diagnosis. By the end of the follow-up, PICP and OC were normalized, whereas the marker of bone resorption (type I collagen carboxyl-terminal telopeptide) was significantly increased. Reduced levels of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and IGF-binding protein-3 were observed during the study.

To conclude, increased bone resorption and impaired development of femoral bone density were observed in children with cancer during chemotherapy. Deficient accumulation of bone mass may lead to impaired development of peak bone mass and predispose children with cancer to increased risk of osteoporosis and diminished skeletal resistance to fractures later in life.

This article has been cited by other articles:

				K. Ruble Skeletal Complications After Bone Marrow Transplant in Childhood Journal of Pediatric Oncology Nursing, April 1, 2008; 25(2): 79 - 85. [Abstract] [PDF]

				K. Wasilewski-Masker, S. C. Kaste, M. M. Hudson, N. Esiashvili, L. A. Mattano, and L. R. Meacham Bone Mineral Density Deficits in Survivors of Childhood Cancer: Long-term Follow-up Guidelines and Review of the Literature Pediatrics, March 1, 2008; 121(3): e705 - e713. [Abstract] [Full Text] [PDF]

				C. Rodgers and R. Monroe Osteopenia and Osteoporosis in Pediatric Patients After Stem Cell Transplant Journal of Pediatric Oncology Nursing, August 1, 2007; 24(4): 184 - 189. [Abstract] [PDF]

				J. E. Brown, S. P. Ellis, P. Silcocks, A. Blumsohn, S. A. Gutcher, C. Radstone, B. W. Hancock, M. Q. Hatton, and R. E. Coleman Effect of chemotherapy on skeletal health in male survivors from testicular cancer and lymphoma. Clin. Cancer Res., November 1, 2006; 12(21): 6480 - 6486. [Abstract] [Full Text] [PDF]

				S. P. Johnsen, H. T. Sorensen, U. Lucht, K. Soballe, S. Overgaard, and A. B. Pedersen Patient-related predictors of implant failure after primary total hip replacement in the initial, short- and long-terms: A NATIONWIDE DANISH FOLLOW-UP STUDY INCLUDING 36 984 PATIENTS J Bone Joint Surg Br, October 1, 2006; 88-B(10): 1303 - 1308. [Abstract] [Full Text] [PDF]

				D. Marinovic, S. Dorgeret, B. Lescoeur, C. Alberti, M. Noel, P. Czernichow, G. Sebag, E. Vilmer, and J. Leger Improvement in Bone Mineral Density and Body Composition in Survivors of Childhood Acute Lymphoblastic Leukemia: A 1-Year Prospective Study Pediatrics, July 1, 2005; 116(1): e102 - e108. [Abstract] [Full Text] [PDF]

				J. Wiernikowski, R. Barr, C Webber, C. Guo, M Wright, and S. Atkinson Alendronate for steroid-induced osteopenia in children with acute lymphoblastic leukaemia or non-Hodgkin's lymphoma: results of a pilot study Journal of Oncology Pharmacy Practice, June 1, 2005; 11(2): 51 - 56. [Abstract] [PDF]

				J. H. Davies, B. A. J. Evans, M. E. M. Jenney, and J. W. Gregory Effects of Chemotherapeutic Agents on the Function of Primary Human Osteoblast-Like Cells Derived from Children J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 6088 - 6097. [Abstract] [Full Text] [PDF]

				S. Wickman, E. Kajantie, and L. Dunkel Effects of Suppression of Estrogen Action by the P450 Aromatase Inhibitor Letrozole on Bone Mineral Density and Bone Turnover in Pubertal Boys J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3785 - 3793. [Abstract] [Full Text] [PDF]

				L. A. Soyka, W. P. Fairfield, and A. Klibanski Hormonal Determinants and Disorders of Peak Bone Mass in Children J. Clin. Endocrinol. Metab., November 1, 2000; 85(11): 3951 - 3963. [Full Text]