Reduced bone density at completion of chemotherapy for a malignancy

Objectives-Osteoporosis and pathological fractures occur occasionally in ch ildren with malignancies. This study was performed to determine the degree of osteopenia in children with a malignancy at completion of chemotherapy. Methods-Lumbar spine (L2-L4) bone mineral density (BMD; g/cm(2)) and femora l neck BMD were measured by dual energy x ray absorptiometry in 22 children with acute lymphoblastic leukaemia (ALL), and in 26 children with other ma lignancies. Apparent volumetric density was calculated to minimise the effe ct of bone size on BMD. Results were compared with those of 113 healthy con trols and expressed as age and sex standardised mean Z scores. Results-Patients with ALL had significantly reduced lumbar volumetric (-0.7 7) and femoral areal and volumetric BMDs (-1.02 and -0.98, respectively). I n patients with other malignancies, femoral areal and apparent volumetric B MDs were significantly decreased (-0.70 and -0.78, respectively). Conclusions-The results demonstrate that children with a malignancy are at risk of developing osteopenia. A follow up of BMD after the completion of c hemotherapy should facilitate the identification of patients who might be l eft with impaired development of peak bone mass, and who require specific i nterventions to prevent any further decrease in their skeletal mass and to preserve their BMD.