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Bone Mineral Density in Childhood Survivors of Acute Lymphoblastic Leukemia Treated without Cranial Irradiation

Department of Pediatric Hematology and Oncology, Royal Manchester Children’s Hospital (B.M.D.B., T.O.B.E., A.M.W.); Department of Pediatric Medicine, Saint Mary’s Hospital for Women and Children (Z.M.); Biostatistics Group, School of Epidemiology and Health Sciences, University of Manchester (S.A.R.); Department of Clinical Radiology, Imaging Science, and Biomedical Engineering, The Medical School, University of Manchester (J.E.A., K.W.); and Department of Endocrinology, Christie Hospital (S.M.S.), Manchester, United Kingdom

Address all correspondence and requests for reprints to: Dr. Bernadette Brennan, Royal Manchester Children’s Hospital, Hospital Road, Manchester, United Kingdom M27 4HA. E-mail: bernadette. brennan{at}cmmc.nhs.uk.

Adult survivors of childhood acute lymphoblastic leukemia (ALL) whose treatment included cranial irradiation (XRT) have reduced bone mineral density (BMD). Fifty-three survivors of ALL (aged 6–17 yr; 22 males and 31 females), who had completed their treatment without XRT, at least 1 yr previously, and 187 (5–19 yr; 86 males and 101 females) healthy controls were examined with dual energy x-ray absorptiometry of the total body and L1–L4 vertebrae and peripheral quantitative computer tomography at the distal and midradial sites. The total body and lumbar spine BMDs did not differ between the ALL survivors and controls. Distal radial trabecular BMD (difference, –0.080 mg/cm³; 95% confidence interval, –0.139 to –0.020; P = 0.009), but not total BMD (difference, –0.006 mg/cm³; confidence interval, –0.051 to 0.039; P = 0.80), was lower in ALL survivors compared with controls. At the midradial site, both endosteal (11% larger; P = 0.0001) and periosteal (4% larger; P = 0.001) circumferences were greater, and cortical thickness was thinner by 6% (P = 0.006) in the ALL subjects, leading to an increase in the axial moment of inertia in the ALL subjects (difference, 13%; P = 0.008). In conclusion, BMD, except at the radius, is normal in childhood survivors of ALL treated without XRT. At the midradial site, we speculate that ALL or its treatment resulted in endosteal bone loss and cortical bone thinning, but the axial moment of inertia and, hence, strength was maintained as a result of bone gain at the periosteal surface.

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