Osteoporosis in Pediatric Cancer

Patients

Allana Boone

Definitions
Osteopenia:

BMD less than normal peak

BMD, but not enough to be classified as
Osteoporosis.

Osteopenia

places individuals at increased

risk of eventually developing osteoporosis

Definitions
Osteoporosis:

Greek; porous bones

ostoun = bone, poros = pore
Progressive bone disease that is
characterized by a decrease in bone
mass/density, deteriorated architecture and
altered mineral content, which can lead to
increased risk of fractures.

Childhood Cancer1,2
1

in 1,000 young adults is a Cancer survivor

Acute

lymphoblastic leukemia (ALL) is the

most commonly diagnosed cancer in children

Overall

long-term survival rate of ALL ~80%

Prevalence of Osteoporosis3
Osteoporosis:
In 1996, 28 million Americans affected by osteoporosis
Estimated 41 million affected in 2015 (NOF)
1.5 million fractures in 1996, costing $14 billion
Predicted 2.25 million fractures costing $60 billion (NOF)
Low BMD in Pediatric Population:
21 65% of survivors
The National Osteoporosis Foundation (NOF)

Why are Pediatric Cancer Patients

at Increased Risk?
Chemotherapy
Radiation

therapy
Corticosteroids
Nutrition status
Physical Inactivity esp. weight bearing
Limited sun exposure
Vitamin D Insufficiency/Deficiency (VDI/VDD)*

Research3

Objective3
Determine

the prevalence of VDI/VDD in

pediatric patients treated with corticosteroids
in comparison to healthy controls. Identify
associations between VDI/VDD with known
risk factors of vitamin D abnormalities, such
as age, race, season, and elevated BMI.

Participants3
Vanderbilt

Pediatric Endocrinology Clinic

171 cancer patients <23 yrs old at diagnosis

97

Treatment with corticosteroids >/=28 days

Feb 08 September 11

healthy controls 0-21 yrs old

June 10 Jan 13
Exclusion criteria noted on next slide

Exclusion Criteria: Healthy Controls3

Excluded patients with diagnosis/prior diagnosis of:

Osteopenia/Osteoporosis
Osteogenesis perfecta
Diagnosed VDI/VDD
>2 bone fractures x past 2 yrs
Chronic or current corticosteroid use
Thyrotoxicosis
Malabsorption disorders
DM
Hx of malignancy/current Dx of malignancy
Non-weight bearing status

Methods3
Medical

record review
Anthropometrics
Liquid chromatography/tandem mass
spectrometry
DXA scan
Statistical Analysis: univariate analysis,
multiple logistic regression models,

Results3

Results3

Results

Interventions
Adequate

dietary vitamin D OR
supplementation (D3)
Encouraging weight bearing exercises
Adequate Ca intake OR supplementation

Careful with supplements and renal patients

Endocrine

consult -- patients with reported

frequent fractures or diagnosis of
osteoporosis

AAP: Vitamin D Recommendation

In

2008, the American Academy of Pediatrics

increased its recommended daily intake of
vitamin D in infants, children, and
adolescents to 400 IU.

No

evidence suggests that this

recommendation is adequate or toxic

Childrens Oncology Group (COG)

Long-term Follow-Up Recommendation:
Begin screening all childhood cancer
survivors ~2 years after completion of
treatment (in remission)
DXA scan
CT scan
Subjective information

Conclusions

Increasing number of cases of pediatric patients with

BMD loss (osteopenia/osteoporosis)
Osteoporosis: global public health problem
Treatments associated with pediatric oncology can
increase risk of BMD loss
Vitamin D/Ca status may predict risk of BMD loss
Exercise and good nutrition are important players in
decreasing risk of BMD loss

Implications for Clinical Practice

Importance of timely interventions I.e. adequate

nutrition, increased exercise, supplementation,
Endocrine consults, DXA/CT scans

Need for more research

References

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