FLUORIDE SUPPLEMENTATION STATUS, FRACTURES AND OSTEOPENIA IN CHILDRENWITH ACUTE LYMPHOBLASTIC-LEUKEMIA

Children with acute lymphoblastic leukemia (ALL) experience fractures on the basis of osteopenia related to chemotherapy administered for th e maintenance of remission. It is likely that corticosteroids are the main cause of bone mineral loss in this circumstance. Because fluoride has been used as a therapeutic intervention in osteoporosis, includin g that induced by corticosteroid therapy, we explored the prospect tha t children with ALL who received fluoride supplementation (in drinking water or from other sources) may be relatively protected from iatroge nic skeletal morbidity. Children who completed therapy according to th e Dana Farber Cancer Institute protocol 87-01 (n=35) were assessed by skeletal radiology and bone densitometry every 6 months from diagnosis . In addition, their families completed a questionnaire relating to fl uoride supplementation. There was no correlation between such fluoride supplementation and either the prevalence of fractures or the severit y of osteopenia. This outcome may reflect the mainly appendicular loca tion of the fractures in this group of children. These findings, toget her with a consideration of the risk benefit ratio of fluoride adminis tration to children at large, suggest that such intervention is unlike ly to be beneficial in limiting skeletal morbidity during the treatmen t of ALL in childhood.