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Skeletal Morbidity in Childhood Acute Lymphoblastic Leukemia

From the Research Institute, Hospital for Sick Children; Department of Pediatrics, University of Toronto, Toronto; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada

Address reprint requests to Paul Pencharz, MB, ChB, PhD, Division of Gastroenterology/Nutrition, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8 Canada; e-mail: paul.pencharz{at}sickkids.ca

PURPOSE: Treatment for acute lymphoblastic leukemia (ALL) in childhood results in a reduction in bone mineral density (BMD). Whether there is a recovery of this lost bone mass in survivors of ALL is not known. We sought to determine if changes in BMD are common long-term sequelae in children with ALL.

METHODS: Bone mineral densitometry of the lumbar spine and femoral neck was performed on 106 patients. The results were compared with those of age-matched normal controls. The effect of treatment was examined in those with low BMD compared with the remainder of the study group.

RESULTS: When data were tested with respect to age, sex, and age and sex, no difference was observed in BMD between survivors of childhood ALL and controls. In the subgroup of patients with low BMD, the difference was not related to age, age at diagnosis, or years since diagnosis. Low BMD of the spine was not explained by radiotherapy (RT), methotrexate (MTX) dose, or corticosteroid dose. Low BMD of the femur was not explained by RT. However, those with low femoral BMD were more likely to have received high-dose MTX or higher-dose corticosteroids compared with the remainder of the group.

CONCLUSION: It appears that survivors of childhood ALL as a whole recover normal BMD. However, those patients who received a total MTX dose of greater than 40,000 mg/m² or a total corticosteroid dose of greater than 9,000 mg/m² may not recover normal BMD and therefore should be screened for decreased BMD of the femoral neck.

Supported by a grant from the Pediatric Oncology Group of Ontario.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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