Osteopenia and cancer in children and adolescents

The fragility of success


  • Alessandra Sala MD, PhD,

    1. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
    2. Department of Pediatrics, University of Milan-Bicocca, San Gerardo Hospital, Monza, Milan, Italy
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    • Dr. Sala held an American Cancer Society UICC International Fellowship for Beginning Investigators during the preparation of this review.

  • Ronald D. Barr MB, ChB, MD

    Corresponding author
    1. Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
    • Health Sciences Centre, Room 3N27, McMaster University, 1200 Main Street West, Hamilton, ON, L8S 4J9, Canada
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    • Fax: (905) 521-1703.


The attainment of a satisfactory peak bone mass, which is accomplished largely by the end of adolescence, is the best protection against excessive bone mineral loss in late adulthood. Factors that influence this process include age, race, sex, body size, pubertal status, diet, physical activity, and other lifestyle elements. Cancer and its treatment in children and teenagers adversely impact bone mineralization. In particular, chemotherapy (especially glucocorticosteroids and methotrexate) and cranial irradiation (apparently by reducing growth hormone secretion and by causing hypogonadotropic hypogonadism) interfere with normal bone turnover. Resorption often exceeds formation, resulting in net bone mineral loss and providing a rational basis for the use of antiresorptive drugs. Such osteopenia may be symptomatic, with pain and abnormal gait, and increases the risk of fractures several fold. The disorder is compounded by reduced physical activity, so programs to reduce this deficit are of measurable benefit. All of those engaged in the care of children and adolescents with cancer have an opportunity to improve the bone health of these young people and to limit their risk of developing osteoporosis and fragility fractures in adult life. Cancer 2007;. © 2007 American Cancer Society.