Bone mass after treatment for acute lymphoblastic leukemia in childhood

Purpose: To study bone mass after childhood acute lymphoblastic leukemia (A LL) and determine if reduced bone mass is related to previous therapy or en docrine status at follow-vp. Patients and Methods: We studied 95 survivors of childhood ALL who were in first remission a median of 11 years (range, 3 to 23 years) after diagnosis and who had never been irradiated outside a cranial field. The bone mass w ets measured by dual-energy x-ray absorptiometry. The results were compared with data on 396 local controls. Results: Adjusted for sex and age, the mean whole-body bone mineral content (BMC) and bone mineral areal density (BMDA) were both significantly reduce d (0.4 SDs less than the predicted mean value). This was mainly caused by r educed bone mass in the 33 participants who were aged 19 years or older at follow-up. In these young adults, the mean height for age, bone area for he ight, and BMC for bone area were all significantly reduced. This indicated that the reduced whole-body bone mass was caused by both reduced bone size and reduced size-adjusted bone mass. Reduced bone size was related to previ ous cranial irradiation. Reduced size-adjusted bone mass was not significan tly related to age at diagnosis or at follow-up, length of follow-up, crani al irradiation, cumulative dose of methotrexate or corticosteroids, or endo crine status at follow-up. Conclusion: The whole-body bone mass was reduced 11 years after diagnosis o f childhood ALL. If these abnormalities remain, survivors of childhood ALL will have an increased risk for osteoporotic fractures later in life. (C) 1 998 by American Society of Clinical Oncology.