ESPE Abstracts

Introduction: Children with cancer are at increased risk of endocrine complications, especially children with a brain tumor. One of these late effects includes bone disorders (ranging from low bone mineral density (BMD) to osteoporosis). Children with a suprasellar Low Grade Glioma (LGG) may be especially at risk for bone problems due to exposure to multiple treatment modalities, hypothalamic dysfunction and/or decreased mobility in combination with vision loss. We aimed to identify the prevalence and risk factors for bone problems in children with suprasellar LGG to guide clinical decision making.

Methods: A retrospective study was performed in children aged ≤ 18 years at diagnosis of a suprasellar or thalamic LGG between 1-1-2003 and 1-1-2021. Optic pathway gliomas without involvement of the optic chiasm were excluded. Bone problems were defined as presence of vertebral fractures, any fractures not related to (the intensity of) trauma, treatment with bisphosphonates, very low BMD as measured by DXA scanning or by Bone Health Index using digital X-ray radiogrammetry (Z score below -2 SDS) or spine collapse on MRI scan or X-ray of the spine.

Results: In total, 139 children were included with a median age at diagnosis of 4.7 years and median follow-up time of 7.6 years. ‘Any’ bone problem occurred in 25.2% (35/139) of the children. Diencephalic syndrome history, blindness, hypothalamic syndrome, thyroid-stimulating hormone deficiency, growth hormone deficiency, adrenocorticotropic hormone deficiency, hypogonadism, and glucocorticoid over-exposure were associated with bone problems. No independent risk factor could be identified for bone problems by multivariate analysis.

Conclusion: Bone problems are prevalent in children with suprasellar LGG and the results from this study may even be an underestimation. The origin of bone problems appears to be multifactorial in these children. Given this high prevalence, bone health must be a point of awareness in the care and follow-up in children with suprasellar LGG.