Background: Acute lymphoblastic leukemia (ALL) is the most common paediatric cancer. Skeletal morbidity has been recognized as a complication of ALL and its treatment, occurring at diagnosis, during chemotherapy and/or years later.
Aim: To describe the adversely effect on bone health, in terms of vertebral fractures (VF) and bone mineral density (BMD), in the follow-up of children with ALL.
Design, patients and methods: Descriptive and retrospective study. Children with ALL were selected from the Endocrinology Division of Hospital de Niños Ricardo Gutierrez. Clinical and auxological characteristic were recorded. VF and BMD which were assessed by lateral thoracolumbar spine radiographs (according to the Genant method) and dual-energy x-ray absorptiometry (DXA, using either Hologic or Lunar Prodigy), respectively. Estimates (months) of the presence of VF or abnormal BMD were evaluated since diagnosis.
Results: 29 children with ALL were included (age at diagnosis: 5.38±3.16 years). The follow up time was 46.21±42.10 months. Twenty-two were assessed with lateral spine radiograph and 26 with DXA. Only 7/29 children under chemotherapy had VF, 5 within the first 12 months of treatment and 2 during the second year of treatment. No further VF were detected along follow-up. A low BMD was identified in 5/26 patients, 2 of them during the first year of treatment (DXA Lunar Z score=−4.0, and DXA Hologic Z score=−3.9) and both also had VF in the second year. The other 3 children developed low BMD on follow up (84.33±74.54 months): DXA Hologic Z score =−2.1 (n=1) and DXA Z Score Lunar=−3.05±1.3 (n=2). All patients improve their BMD. However, only 2/5 normalized their values. Back pain was not a constant symptom associated with VF and only appeared in 2/7 children with VF.
Conclusion: VF are common in children with ALL and is more prevalent along the first year of treatment. Usually are asymptomatic, therefore might remain undetected if routine surveillance is not performed. The BMD can be affected too, so an early diagnosis and intervention should be considered in order to prevent compromise of future peak bone mass.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology