Impaired development of bone mineral density during chemotherapy: A prospective analysis of 46 children newly diagnosed with cancer

Osteopenia and osteoporosis are becoming increasingly recognized in childre n with cancer, though reasons for these changes are poorly understood. The purpose of the present study was to evaluate longitudinal changes in bone m ineral density (BMD) and bone turnover in newly diagnosed children with a m alignancy. Lumbar spine (L2-L4) and femoral neck bone mineral density (BMDa real, g/cm(2)) was measured by dual-energy X-ray absorptiometry in 46 child ren (age 2.9-16.0, median 8.0 years; 15 leukemias, 12 lymphomas, 19 solid t umors) at diagnosis, and after 6 months from the baseline. The apparent vol umetric bone mineral density (BMDvol) was calculated to minimize the effect of bone size on BMD, Serum levels of osteocalcin (OC), type I collagen car boxy-terminal propeptide (PICP), and type I collagen carboxy-terminal telop eptide (ICTP) were analyzed at diagnosis, and during a 6-month follow-up. A significant decrease in lumbar BMDvol (-2.1%, p < 0.05), and in femoral BM Dareal (-9.9%, p = 0.0001) and BMDvol (-8.5%, p = 0.0001) was observed afte r 6 months when compared with baseline measurements. The markers of bone fo rmation (PICP, OC) were significantly decreased, and the marker of bone res orption (ICTP) was significantly increased at diagnosis as compared,vith no rmal values. By the end the follow-up, the levels of PICP and OC were norma lized, whereas the level of ICTP continued to increase indicating that ther e was a negative balance in bone turnover. A deficient accumulation of bone mass might predispose children,vith a malignancy to impaired development o f peak bone mass. A controlled study determining the benefits of an early i ntervention on bone turnover should be considered in these patients.