ESPE Abstracts (2019) 92 RFC2.4

Bone Mass and Fracture Prevalence in Childhood Brain Cancer Survivors 2, 5 or 7 Years After Off Therapy

Annalisa Gallizia1, Vera Mauro1, Marco Crocco1, Anna Elsa Maria Allegri2, Flavia Napoli2, Maria Luisa Garrè3, Mohamad Maghnie1, Natascia Di Iorgi1


1Department of Pediatrics, Giannina Gaslini Institute, University of Genova, Genova, Italy. 2Department of Pediatrics, Giannina Gaslini Institute, Genova, Italy. 3Department of Neuro-oncology, Giannina Gaslini Institute, Genova, Italy


Background and Aim: Multifaceted risk factors impair bone mass (BM) in childhood brain cancer survivors(CBCS). Aims of the study were to evaluate bone mass and it's determinant and fracture prevalence in CBCS 2(G+2), 5(G+5) or 7(G+7) years after off therapy (OT).

Methods: Seventy-three(G+2), 87(G+5) and 66(G+7)CBCS were evaluated at 12,9±4,2, 14,9±4,4 and 16,6±4,4yrs, respectively. Diagnoses were: astrocytic (G+2:n=25,G+5:n=24,G+7:n=20), embryonal (G+2:n=19,G+5:n=28,G+7:n=20), germinomas (G+2:n=13,G+5:n=18,G+7:n=12), sellar region (G+2:n=13,G+5:n=10,G+7:n=9), ependimal (G+2:n=3,G+5:n=7,G+7:n=5) tumors. Twenty-six, 37 and 27 pts, respectively, underwent CSRT in the 3 groups. Growth hormone deficiency(GHD) was diagnosed in 38(G+2), 66(G+5) and 46(G+7) pts, while hypogonadism(HH) in 15(G+2), 28(G+5) and 22(G+7)CBCS. Patients underwent height and BMI(SDS), pubertal(Tanner) and DXA(Lunar Prodigy Advance) measurements. BMD(g/cm2,Z-score), BMC(g) were obtained at the lumbar spine(L1–L4=L) and the total body less head(TB); lumbar BMAD(g/cm3) was calculated; fat(FM,Kg) and lean mass(LM,Kg) were obtained.

Results: The 3 groups had similar age at diagnosis (8,0±4,2yrs), height (-0,5±1,4SDS), BMI (0,7±1,2SDS); G+7 had higher FM and LM than G+2 and G+5 (FM:P's=0,01 and 0,003 respectively; LM:P's=0,0008 and 0,03). G+2 showed a reduced LBMD and LBMC compared to G+5 and G+7 (LBMD:P's=0,009 and <0,0001; for LBMC:P's=0,03 and 0,0003, respectively) and a non-significant lower LBMDZ-score (-0,85±1,33,-0,61±1,23 and-0,74±1,31) and TBBMDZ-score (-0,72±1,09,-0,59±1,04 and-0,51±1,14). BMAD was significantly higher (P=0,03) in G+7(0,157±0,083) compared to G+2(0,135±0,021). A LBMD<-2Z-score was present in 19,2%, 11,5% and 17,7% (G+2vsG+5vsG+7) and a TBBMD<-2Z-score in 14,1%, 11,9% and 12,5% (G+2vsG+5vsG+7). G+2GHD pts had lower LBMDZ-score(P=0,01) and TBBMDZ-score(P=0,04) compared to G+5GHD pts; G+2HH pts had lower LBMDZ-score and TBBMDZ-score compared to G+5HH (P=0,009 and 0,03, respectively). TBBMDZ-score progressively increased in pts not treated with CSRT, while remained below -0.9Z-score in treated-ones. In multivariable analyses LBMDZ-score was inversely predicted by age and directly by height after correction for LM, FM, GHD, HH; TBBMDZ-score was additionally predicted by LM and GHD. Seven% CBCS in G+2(5/73), 2,3% in G+5(2/87) and 1,5% in G+7(1/66) presented fractures.

Conclusions: Older, shorter, GHD, CSRT treated and HH CBCS are at risk of decreased BM after 2 yrs OT; a low BM might persist after 5 and 7 yrs OT; the fracture prevalence remains low.

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