ESPE Abstracts (2016) 86 P-P1-128

Childhood Cancer Survivors (CCS) are at High Risk of Reduced Bone Mass During the Second Decade of Life

Natascia Di Iorgia,b, Vera Morsellinoc, Annalisa Galliziab, Angela Pistoriod, Federica Ceronee, Ramona Tallonea,b, Riccardo Hauptd & Mohamad Maghniea,b


aUniversity of Genoa, Genoa, Italy; bDepartment of Clinical and Experimental Endocrinology, “Giannina Gaslini” Institute, Genoa, Italy; cDepartment of Hematology, Oncology and Bone Marrow Transplantation, “Giannina Gaslini” Institute, Genoa, Italy; dEpidemiology, Biostatistics and Committees Unit, “Giannina Gaslini” Institute, Genoa, Italy; eGreat Ormond Street Hospital, Pediatric and Neonatal Department, London, UK


Background: Childhood cancer survivors (CCS) are at risk for low bone mineral density (BMD).

Objective: Aim of our study was to evaluate the prevalence of low BMD and it’s determinants in a single-center cohort of CCS.

Method: One-hundred-eighty-five CCS (103M, 84F) diagnosed with liquid-LT-(n=48), solid-ST-(n=88) and brain tumor-BT-(n=51) at the age of 5.3±3.2 years underwent height, BMI (SDS), Tanner staging and DXA scan for total body-TB and spine-L1-L4 BMD (gr/cm2, Z-score), BMC (gr) and for TB fat mass(FM, kg) and free fat mass (FFM, kg). Endocrine defects were found in n=9LT, n=16ST and n=50BT; 48/51BT underwent CRT(mean total dose 5397.5±1426.1 cGy).

Results: Patients were evaluated 6.8±3.3 years after off therapy at the age of 13.0±2.0 years. LT were significantly younger than BT (12.9±1.8 vs 13.7±1.7 years) and BT shorter than ST (−0.60±1.26 vs 0.24±1.37 SDS, P<0.001); the 3 categories did not differ for Tanner stage nor for BMI SDS (range 1.34-LT to 1.57-BT). BT presented a lower TBBMD (−0.61±0.89) and L1-L4BMD Z-scores (−0.74±1.14) compared to ST and LT (P’s<0,01). A TBBMD Z-score <−2 and between −2 and −1 was found in 4.8% (7.8%-BT, 6.5%-LT and 2.2%-ST) and 14% (23.5%-BT, 6.2%-LT and 12.6%-ST) of CCS, respectively; a L1-L4BMD Z-score <−2 and between −2 and −1 in 7% (13.7%-BT, 6.5%-LT and 3.4%-ST) and 15.6% (19.6%-BT, 16.7%-LT and 12.6%-ST), respectively. TBBMD Z-score was directly associated to FFM (r’s=0.51) and inversely to RT dose in BT (r=−0.30, P=0.037); hormone defects were inversely related to L1-L4 and TBBMD Z-scores in LT and ST, but not in BT. Multiple regression analyses showed that L1-L4BMD Z-score was independently and inversely predicted by age and hormone defects and directly by FFM and FM after correction for Tanner stage and height SDS (R2 0.33, P<0.0001), while TBBMD Z-score by all the previous parameters, except for Tanner stage (R2 0.50, P<0.0001).

Conclusion: Up to 14% of BTCCS and 6.5% of LTCCS present a low bone mass at the age of 13 years. Older age, hormone defects and CRT are negative predictors of low BMD.

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