Disturbance in bone turnover in children with a malignancy at completion of chemotherapy

Background. Osteoporosis and pathological fractures have been observed in c hildren with a malignancy. The mechanisms of osteopenia in childhood malign ancies have not been well established. The purpose of the present study was to evaluate changes in bone turnover and in bone hormonal metabolism in ch ildren with a malignancy at completion of their chemotherapy. Procedure. Se rum levels of human intact osteocalcin, type I collagen carboxyterminal pro peptide (PICP), type I collagen carboxyterminal telopeptide (ICTP), 25-hydr oxyvitamin D [25-(OH)-D], 1,25-dihydroxyvitamin D [1,25-(OH)(2)-D], intact parathyroid hormone, insulin-like growth factor I (ICF-I), ICF binding prot ein 3 (IGFBP-3), alkaline phosphatase, calcium, and phosphate were analyzed in 22 children with acute lymphoblastic leukemia and in 26 children with o ther malignancies. Results were expressed as Z-scores [mean (95% confidence intervals)] relative to healthy Caucasian-children. Results. The marker of collagen degradation (ICTP) was significantly increased [1.43 (1.10-1.76), P < 0.0001] compared to reference values, whereas the markers of bone form ation (PICP, osteocalcin) were not changed [0.07 (-0.55 to 0.49), 0.35 (-0. 05 to 0.74), respectively, NS]. Serum 25-(OH)-D, 1,25-(OH)(2)-D, and calciu m were significantly reduced [-0.65 (-0.87 to -0.42), -0.68 (-0.92 to -0.42 ), -1.42 (-1.80 to -1.04), P < 0.0001, respectively]. Conclusions. Disturba nce in bone turnover with low serum 25-(OH)-D, 1,25-(OH)(2)-D, and calcium was observed in children with a malignancy at completion of their chemother apy. A controlled study determining the possible benefits of vitamin D and calcium supplementation on bone turnover could be considered in these patie nts. (C) 1999 Wiley-Liss, Inc.