Muszynska-Roslan Katarzyna, Konstantynowicz Jerzy, Panasiuk Anna, Krawczuk-Rybak Maryna
Department of Pediatric Oncology, Medical University of Bialystok, Bialystok, Poland.
Pediatr Hematol Oncol. 2009 Jan;26(1):36-47. doi: 10.1080/08880010802625472.
Cancer disease and its therapy (e.g., chemotherapeutic agents such as glucocorticoids, methotrexate, antymetabolities, cranial and local irradiation) may severely disturb normal growth, bone mineral acquisition, and skeletal development because most individuals go through the stages of rapid growth when childhood cancer is diagnosed.
To identify factors associated with reduced bone mineral density (BMD) in survivors of childhood cancer the authors examined 114 patients (70 males) who had been treated for acute lymphoblastic leukemia (ALL; n = 43), Hodgkin disease (HD; n = 35), and solid tumors (ST; n = 36) twice. Median age at diagnosis was 8.4 years; at the consecutive examinations it was 12.8 and 16.3 years, respectively. To assess bone density we used dual-energy x-ray absorptiometry (DXA).
In the first examination, patients with a history of steroid therapy had higher total and spine BMD and higher BMI (body mass index) than those who were not given steroids. At the end of the follow-up, no differences were found in BMD between subgroups, although BMI was still higher in both ALL and HD patients than in those with ST.
Patients treated for solid tumors have reduced bone mass. Low BMI and local irradiation seem to be the factors responsible for reduced BMD in children treated for ST. The use of steroids does not disturb bone mass accumulation in patients treated for childhood malignancies. However, a long-term effect of cancer treatment on osteoporosis risk remains to be determined.
癌症疾病及其治疗方法（例如，化疗药物如糖皮质激素、甲氨蝶呤、抗代谢药物、颅脑和局部放疗）可能会严重干扰正常生长、骨矿物质获取和骨骼发育，因为大多数个体在被诊断为儿童癌症时正处于快速生长阶段。
为了确定儿童癌症幸存者骨密度（BMD）降低的相关因素，作者对114例患者（70例男性）进行了两次检查，这些患者曾接受过急性淋巴细胞白血病（ALL；n = 43）、霍奇金病（HD；n = 35）和实体瘤（ST；n = 36）的治疗。诊断时的中位年龄为8.4岁；在随后的检查中，分别为12.8岁和16.3岁。为了评估骨密度，我们使用了双能X线吸收法（DXA）。
在第一次检查中，有类固醇治疗史的患者的总骨密度和脊柱骨密度以及体重指数（BMI）均高于未使用类固醇的患者。在随访结束时，各亚组之间的骨密度没有差异，尽管ALL和HD患者的BMI仍然高于ST患者。
接受实体瘤治疗的患者骨量减少。低BMI和局部放疗似乎是导致接受ST治疗的儿童骨密度降低的因素。使用类固醇不会干扰接受儿童恶性肿瘤治疗患者的骨量积累。然而，癌症治疗对骨质疏松风险的长期影响仍有待确定。
