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

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 (BMD_TB) and BMD of the lumbar spine (BMD_LS) were measured by dual X-ray absorptiometry. Osteopenia was defined as BMD standardized deviation score (SDS) below −1.

Results: Survivors had a lower BMD_TB and BMD_LS (mean SDS −0.55; p < 0.001 and −0.30; p < 0.001, respectively) as compared to healthy peers. Osteopenia (BMD_TB and/or BMD_LS) 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.