Calcium Metabolism and Osteoporosis Program, Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020 Beirut, Lebanon.
Osteoporos Int. 2012 Feb;23(2):665-74. doi: 10.1007/s00198-011-1605-2. Epub 2011 Apr 8.
Twenty-nine children with malignancies and age, gender-matched controls were prospectively studied over 14 months. Patients had higher parathyroid hormone (PTH) levels and fat mass, lower bone mass, and bone mass increments at follow-up than controls. Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses.
Children with hematologic malignances have low bone mass. We prospectively investigated anthropometric, clinical, and hormonal predictors of changes in bone mass in children receiving cancer therapy.
Twenty-nine children, mean age of 9 ± 2.9 years and 32 age and gender-matched controls, were studied. Seven had completed their course 40 ± 22 weeks prior, while 22 were still receiving therapy for 80 ± 28 weeks. Age at diagnosis, calcium intake, exercise activity, systemic corticosteroids in dexamethasone (Dex) dose, and methotrexate (MTX), and intrathecal MTX therapy received within follow-up period were assessed. Routine chemistries, PTH, 25-hydroxy vitamin D (25-OHD), bone remodeling markers, bone mass, and body composition were measured at baseline and 14 months.
Patients had lower exercise activity, sun exposure, and bone markers levels than controls. They had higher PTH levels and fat mass, lower bone mass at the spine, hip, and total body, and lower increments at these sites on follow-up. Predictors of bone mass changes on univariate analyses were: age at diagnosis (R = -0.50 to -0.44, p < 0.05), Dex-MTX doses (R = -0.58 to -0.41, p < 0.05), intrathecal therapy (p < 0.03),% changes in lean mass (R = 0.37 to 0.54, p < 0.04), 25-OHD levels (R = 0.39, p < 0.03), and PTH levels (R = -0.47 to -0.41, p < 0.05). Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses.
This study provides insight into the pathophysiology of bone loss in children receiving cancer therapy and possible interventions to optimize their skeletal health.
本研究前瞻性地对 29 名患有恶性肿瘤的儿童和年龄、性别匹配的对照组进行了研究，共随访 14 个月。与对照组相比，患者的甲状旁腺激素（PTH）水平和脂肪量较高，骨量较低，随访时骨量增加也较低。经调整分析，瘦体重、诊断时年龄、全身和鞘内治疗是骨量变化的预测因素。
患有血液系统恶性肿瘤的儿童骨量较低。本研究前瞻性地研究了接受癌症治疗的儿童骨量变化的人体测量、临床和激素预测因素。
研究纳入了 29 名儿童，平均年龄为 9±2.9 岁，32 名年龄和性别匹配的对照组。其中 7 名儿童在 40±22 周前完成了治疗，而 22 名儿童仍在接受 80±28 周的治疗。评估了诊断时的年龄、钙摄入量、运动活动、全身皮质类固醇（地塞米松 [Dex] 剂量）和甲氨蝶呤（MTX）、以及在随访期间接受的鞘内 MTX 治疗。在基线和 14 个月时测量了常规生化指标、PTH、25-羟维生素 D（25-OHD）、骨重塑标志物、骨量和身体成分。
与对照组相比，患者的运动活动、阳光暴露和骨标志物水平较低。他们的 PTH 水平和脂肪量较高，脊柱、臀部和全身的骨量较低，随访时这些部位的骨量增加也较低。单变量分析中骨量变化的预测因素包括：诊断时年龄（R=-0.50 至-0.44，p<0.05）、Dex-MTX 剂量（R=-0.58 至-0.41，p<0.05）、鞘内治疗（p<0.03）、瘦体重变化百分比（R=0.37 至 0.54，p<0.04）、25-OHD 水平（R=0.39，p<0.03）和 PTH 水平（R=-0.47 至-0.41，p<0.05）。经调整分析，瘦体重、诊断时年龄、全身和鞘内治疗是骨量变化的预测因素。
本研究深入了解了接受癌症治疗的儿童骨丢失的病理生理学，并为优化其骨骼健康提供了可能的干预措施。
