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Total body bone measurements: A cross-sectional study in children with acute lymphoblastic leukemia during and following completion of therapy

  1. Kara M. Kelly MD1,*,
  2. John C. Thornton PhD2,
  3. Deborah Hughes MPH1,
  4. Ifeyinwa Osunkwo MD, MPH1,
  5. Michael Weiner MD1,
  6. Jack Wang MS2,
  7. Mary Horlick MD3

Article first published online: 24 SEP 2008

DOI: 10.1002/pbc.21760

Issue

Pediatric Blood & Cancer

Pediatric Blood & Cancer

Volume 52, Issue 1, pages 33–38, January 2009

Additional Information

How to Cite

Kelly, K. M., Thornton, J. C., Hughes, D., Osunkwo, I., Weiner, M., Wang, J. and Horlick, M. (2009), Total body bone measurements: A cross-sectional study in children with acute lymphoblastic leukemia during and following completion of therapy. Pediatric Blood & Cancer, 52: 33–38. doi: 10.1002/pbc.21760

Author Information

  1. 1

    Division of Pediatric Oncology, Columbia University Medical Center, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York

  2. 2

    Body Composition Unit, St Luke's-Roosevelt Hospital Center, New York, New York

  3. 3

    Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland

*Division of Pediatric Oncology, Columbia University Medical Center, 161 Fort Washington Avenue, Irving Pavilion 7, New York, NY 10032.

Publication History

  1. Issue published online: 12 NOV 2008
  2. Article first published online: 24 SEP 2008
  3. Manuscript Accepted: 7 AUG 2008
  4. Manuscript Received: 25 FEB 2008

Funded by

  • Joseph LeRoy and Ann C. Warner Fund, Inc.

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Keywords:

  • bone mass;
  • bone mineral density;
  • dual-energy X-ray absorptiometry;
  • pediatrics

Abstract

Background

Abnormalities in bone mineral density (BMD) occur in children treated for acute lymphoblastic leukemia (ALL). However, BMD estimates have been performed using varied instruments, reference data, and interpretations. This exploratory cross sectional study to evaluate bone mass in children with ALL, uses an algorithm that serially adjusts for variables known to affect pediatric bone measures by dual energy X-ray absorptiometry (DXA), based on models developed in 1,218 healthy children and adolescents.

Procedure

Anthropometry, DXA scans, and factors with possible influence on bone mass were evaluated in 21 ALL patients receiving chemotherapy and 20 in the follow-up phase. Main outcome was treatment group differences in Z-scores for total body bone mineral content (BMC), bone area (Area), and areal BMD (aBMD).

Results

Mean Z-scores for the entire study population for BMC, Area, and aBMD were significantly less than zero. Among possible contributing factors, only calcium intake was a significant co-variate. Comparison between treatment groups showed that least-square mean Z-scores for patients on-therapy for at least 12 months were significantly lower than those off therapy for at least 12 months (P: 0.0008–0.044), except for BMC at last step of the algorithm (adjusted for sex, age, ethnicity, height, weight, and bone area).

Conclusions

Evaluation of total body DXA by this algorithm is consistent with better general bone status in those off-therapy. However, in this small exploratory study, the lack of significant difference between Z-scores for fully adjusted BMC in on- versus off-therapy groups suggests possible risk of low peak bone mass. Additional longitudinal evaluation is warranted. Pediatr Blood Cancer 2009;52:33–38. © 2008 Wiley-Liss, Inc.

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