Lethaby Christopher, Wiernikowski John, Sala Alessandra, Naronha Marissa, Webber Colin, Barr Ronald D
University of Leeds, Leeds, United Kingdom, and McMaster Children's Hospital, Hamilton, Canada.
J Pediatr Hematol Oncol. 2007 Sep;29(9):613-6. doi: 10.1097/MPH.0b013e318142b7a1.
Osteopenia is a common consequence of the treatment of acute lymphoblastic leukemia (ALL) in children and adolescents, due predominantly to glucocorticosteroid therapy. The pathogenesis relates to an imbalance of resorption over formation of bone.
Alendronate (Fosamax), an inhibitor of osteoclastic bone resorption, was administered for at least 6 months to 15 children with ALL during maintenance chemotherapy, after the diagnosis of osteopenia/osteoporosis by dual energy x-ray absorptiometry. The height velocity was also measured during the administration of alendronate and again 2 years later.
Areal bone mineral density Z scores of the lumbar spine had a median value of -1.32 before administration of alendronate and a median gain of +0.64, with 14/15 children showing improvement. There was no adverse effect of alendronate on height velocity, and the drug was well tolerated with no short-term toxicity.
This preliminary experience suggests a potential value in the use of alendronate for the treatment of osteopenia/osteoporosis in children with ALL and points to the need for a randomized controlled trial of this intervention.
骨质减少是儿童和青少年急性淋巴细胞白血病（ALL）治疗的常见后果，主要归因于糖皮质激素治疗。其发病机制与骨吸收超过骨形成的失衡有关。
在通过双能X线吸收法诊断为骨质减少/骨质疏松后，对15例ALL患儿在维持化疗期间给予阿仑膦酸盐（福善美），一种破骨细胞骨吸收抑制剂，治疗至少6个月。在给予阿仑膦酸盐期间及2年后再次测量身高增长速度。
腰椎的骨密度Z值在给予阿仑膦酸盐前中位数为-1.32，中位数增加了+0.64，15例患儿中有14例显示改善。阿仑膦酸盐对身高增长速度无不良影响，该药物耐受性良好，无短期毒性。
这一初步经验表明，阿仑膦酸盐在治疗ALL患儿的骨质减少/骨质疏松方面具有潜在价值，并指出需要对该干预措施进行随机对照试验。
