Bone mass after treatment of malignant lymphoma in childhood

Authors

  • Karsten Nysom MD, PhD,

    Corresponding author
    1. Section of Paediatric Haematology and Oncology, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
    • Kurvej 16, DK-2880 Bagsværd, Denmark.
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  • Kirsten Holm MD, PhD,

    1. Department of Growth and Reproduction, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
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  • Kim Fleischer Michaelsen MD, DMSc,

    1. Research Department of Human Nutrition and Centre for Advanced Food Studies, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
    2. Paediatric Nutrition Unit, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
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  • Henrik Hertz MD, DMSc,

    1. Section of Paediatric Haematology and Oncology, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
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  • Jørn Müller MD, DMSc,

    1. Department of Growth and Reproduction, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
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  • Christian Mølgaard MD, PhD

    1. Research Department of Human Nutrition and Centre for Advanced Food Studies, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
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Abstract

Background

Sex hormone deficiency, growth hormone deficiency, skeletal irradiation, and treatment with corticosteroids or methotrexate may all cause reduction in bone mass after treatment for childhood malignant lymphoma. Previous studies of the bone mass of childhood cancer survivors often lacked adequate local reference data, and survivors of malignant lymphoma were never analyzed separately.

Procedure

The bone mass of survivors of childhood Hodgkin disease (n = 23) or non-Hodgkin lymphoma (n = 21) was measured by dual-energy X-ray absorptiometry a median of 11 years after diagnosis (range 2–25). Results were compared with local data on 463 healthy controls.

Results

Adjusted for gender and age, the mean whole-body bone mineral content and bone mineral areal density were slightly, but significantly, reduced (0.5 and 0.4 SD lower than predicted). The reduced bone mineral content was associated with a significantly reduced height, whereas the size-adjusted bone mass (bone mineral content for bone area) did not differ significantly from that of controls. Lower height was related to male gender and to cranial, thoracic, and lumbar spine irradiation. Whole-body bone mineral content and bone mineral density were lower in persons treated with lumbar spine irradiation and whole-body bone mineral content was higher in nine women receiving sex hormone replacement therapy or oral contraceptives. Whole-body bone mass was not related to the cumulated doses of corticosteroids or methotrexate.

Conclusions

Eleven years after diagnosis of childhood Hodgkin disease or non-Hodgkin lymphoma, the whole-body bone mass of survivors was only slightly reduced and the size-adjusted bone mass was normal. Med Pediatr Oncol 2001;37:518–524. © 2001 Wiley-Liss, Inc.

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