Department of Pediatric Hematology Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India.
Department of Endocrinology, Max Superspeciality Hospital, Saket, New Delhi, India.
Pediatr Blood Cancer. 2017 Apr;64(4). doi: 10.1002/pbc.26271. Epub 2016 Sep 26.
Acute lymphoblastic leukemia (ALL) and its treatment are often implicated in adversely affecting bone health. Conflicting reports in the literature and a paucity of studies from the developing world prompted us to study bone mineral density (BMD) in childhood ALL survivors.
BMD lumbar spine (LS) and whole body (WB) were evaluated, using dual energy x-ray absorptiometry in 65 pediatric ALL survivors who had been off-therapy for at least 2 years. The control group constituted of 50 age- and sex-matched healthy siblings. Kernel density plots were used to compare BMD among cases and controls. The disease-, treatment-, hormone- and lifestyle-related factors likely to modulate BMD were analyzed using the Mann-Whitney U test and Student's t-test.
At a median of 4.3 years (range, 2-14.8 years) since cessation of therapy, height-adjusted (HA) mean BMD Z-scores of LS (-0.67 ± 1.11, -0.607 ± 1.05, P = 0.759) and WB (-0.842 ± 0.92, -0.513 ± 0.97, P = 0.627) were comparable among the cases and controls. Disease, treatment (chemotherapy, cranial radiotherapy) and endocrine factors did not predict low BMD. However, survivors with calcium intake <800 mg/day (WB, P = 0.018) and hypovitaminosis D (≤25 nmol/L) had lower BMD values (HA-WB, P = 0.046) than the controls. A significant proportion of survivors were overweight or obese and had higher BMD Z-scores (HA-LS, P = 0.003; HA-WB, P = 0.028).
BMD Z-scores were similar among ALL survivors and controls. It was reassuring that there was no detrimental impact of the disease or its treatment on BMD. Future studies are required to determine the best possible ways to target the modifiable risk factors (diet, vitamin D) to optimize bone health.
急性淋巴细胞白血病（ALL）及其治疗常被认为会对骨骼健康产生不利影响。文献中存在相互矛盾的报告，且来自发展中国家的研究较少，这促使我们研究儿童 ALL 幸存者的骨密度（BMD）。
使用双能 X 射线吸收法评估 65 名已停止治疗至少 2 年的儿科 ALL 幸存者的腰椎（LS）和全身（WB）BMD。对照组由 50 名年龄和性别匹配的健康兄弟姐妹组成。使用核密度图比较病例组和对照组之间的 BMD。使用 Mann-Whitney U 检验和学生 t 检验分析可能调节 BMD 的疾病、治疗、激素和生活方式相关因素。
在停止治疗后的中位数为 4.3 年（范围 2-14.8 年），LS（-0.67 ± 1.11，-0.607 ± 1.05，P = 0.759）和 WB（-0.842 ± 0.92，-0.513 ± 0.97，P = 0.627）的身高校正（HA）平均 BMD Z 评分在病例组和对照组之间无差异。疾病、治疗（化疗、颅放疗）和内分泌因素不能预测低 BMD。然而，钙摄入量<800mg/天的幸存者（WB，P = 0.018）和维生素 D 缺乏症（≤25nmol/L）的幸存者的 BMD 值较低（HA-WB，P = 0.046）。相当一部分幸存者超重或肥胖，且 BMD Z 评分较高（HA-LS，P = 0.003；HA-WB，P = 0.028）。
ALL 幸存者和对照组的 BMD Z 评分相似。令人安心的是，疾病或其治疗对 BMD 没有不利影响。未来的研究需要确定针对可改变的危险因素（饮食、维生素 D）的最佳方法，以优化骨骼健康。
