Ambroszkiewicz Jadwiga, Rychłowska-Pruszyńska Magdalena, Chełchowska Magdalena, Rogowska Elzbieta, Rowicka Grazyna, Klepacka Teresa, Gajewska Joanna
Pol Merkur Lekarski. 2014 Aug;37(218):86-90.
Cancer and the use of a comprehensive anti-cancer treatment are unfavorable factors, which have a significant impact on bone mass accumulation, bone mineralization and consequently the occurrence of osteoporosis. Bone turnover is regulated by complex mechanisms, among which an important role play OPG/RANK/RANKL signaling pathway, adipokines, and fetuin-A. The aim of the study was to evaluate bone mineral density and concentrations of leptin and fetuin-A in patients with osteosarcoma after anti-cancer treatment.
The study included 50 children and adolescents aged 10-21 years. The study group consisted of 25 patients with osteosarcoma and 25 healthy counterparts as a control group. The examination was conducted 2 months after the last course of postoperative chemotherapy and included densitometric measurements: bone mineral content (BMC), bone mineral density (BMD), fat mass, lean mass and biochemical measurements: serum concentrations of calcium, magnesium, phosphate, 25-hydroksyvitamin D, alkaline phosphatase, leptin and fetuin-A. Concentrations of leptin and fetuin-A were determined by immunoenzymatic methods.
In patients with osteosarcoma after anti-cancer treatment, we observed significantly reduced bone mineral content, bone mineral density and lean body mass compared with the healthy children (p < 0.05, p < 0.01, p < 0.05, respectively). Mean values of z-score of the whole body BMD and z-score of the lumbar BMD L1-L4 were significantly lower in patients than in the controls (p < 0.001). The serum concentrations of phosphate, magnesium, and alkaline phosphatase in both studied groups were similar, while calcium was significantly lower (p < 0.05) in patients than in the healthy children. The concentration of 25-hydroxyvitamin D was about two-fold lower, while leptin approximately 2.5-fold higher in patients than in the controls. The mean value of fetuin-A was similar in both studied groups. Statistically significant positive correlations between body composition parameters and the values of BMD, as well as between anthropometric parameters and leptin and fetuin-A were observed.
The deficit in bone mass observed in patients with malignant bone tumors after anti-cancer treatment might be the result of decreased serum calcium and vitamin D concentrations. The observed correlation between anthropometric and biochemical parameters may indicate the link between bone and adipose tissue metabolism.
癌症以及综合抗癌治疗的使用是不利因素，对骨量积累、骨矿化以及骨质疏松的发生有重大影响。骨转换受复杂机制调节，其中骨保护素/核因子κB受体活化因子/核因子κB受体活化因子配体（OPG/RANK/RANKL）信号通路、脂肪因子和胎球蛋白-A起重要作用。本研究的目的是评估骨肉瘤患者抗癌治疗后骨密度以及瘦素和胎球蛋白-A的浓度。
本研究纳入了50名年龄在10至21岁的儿童和青少年。研究组由25例骨肉瘤患者组成，25名健康同龄人作为对照组。在术后化疗最后一个疗程后2个月进行检查，包括密度测量：骨矿物质含量（BMC）、骨密度（BMD）、脂肪量、瘦体重，以及生化测量：血清钙、镁、磷、25-羟维生素D、碱性磷酸酶、瘦素和胎球蛋白-A的浓度。瘦素和胎球蛋白-A的浓度通过免疫酶法测定。
与健康儿童相比，抗癌治疗后的骨肉瘤患者骨矿物质含量、骨密度和瘦体重显著降低（分别为p < 0.05、p < 0.01、p < 0.05）。患者全身骨密度的z评分平均值和腰椎L1-L4骨密度的z评分显著低于对照组（p < 0.001）。两个研究组的血清磷、镁和碱性磷酸酶浓度相似，而患者的钙浓度显著低于健康儿童（p < 0.05）。患者的25-羟维生素D浓度约低两倍，而瘦素约高2.5倍。两个研究组的胎球蛋白-A平均值相似。观察到身体成分参数与骨密度值之间以及人体测量参数与瘦素和胎球蛋白-A之间存在统计学上显著的正相关。
抗癌治疗后恶性骨肿瘤患者观察到的骨量不足可能是血清钙和维生素D浓度降低的结果。观察到的人体测量和生化参数之间的相关性可能表明骨与脂肪组织代谢之间的联系。
