Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, USA.
Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, California, USA.
Pediatr Blood Cancer. 2021 Jul;68(7):e29048. doi: 10.1002/pbc.29048. Epub 2021 Apr 6.
Childhood cancer survivors (CCS) have increased risk of developing chronic health conditions, including musculoskeletal disorders. Little is known regarding vitamin D deficiency (VDD, <20 ng/ml) and its association with bone mineral density (BMD) in long-term CCS. We evaluated the prevalence and risk factors for VDD in a large, diverse population of long-term CCS, and examined the association between VDD and BMD in patients who underwent guideline-recommended dual-energy X-ray absorptiometry (DXA) screening.
This cross-sectional study included 446 consecutive CCS seen from March 2018 to September 2020. Univariate analyses examined associations between CCS demographics, socioeconomic status, and treatment exposures and VDD. Multivariable logistic regressions identified factors associated with odds of VDD and reduced BMD.
Median age at evaluation was 27.5 years (range 7-67 years); median time from completing therapy was 14.2 years (range 2-65 years). Fifty percent were female, and 45% were Hispanic. Twenty-four percent had VDD. In multivariable analysis, overweight and obese BMI were associated with VDD (overweight: OR 1.78, 95% CI 1.03-3.07, p = 0.04; obese: OR 2.40, 95% CI 1.39-4.13, p < 0.01; reference: normal/underweight), as was Hispanic or black race/ethnicity (OR 2.40, 95% CI 1.41-4.09, p < 0.01; reference: non-Hispanic white). In the 118 CCS with DXA results, VDD was independently associated with reduced BMD (OR 3.58, 95%CI 1.33-9.59, p = 0.01).
CCS have a high prevalence of VDD. High BMI and Hispanic or black race/ethnicity were associated with VDD. Survivors with VDD had a greater than threefold risk of reduced BMD. Risk-based screening may facilitate timely interventions to mitigate VDD and improve BMD in CCS.
儿童癌症幸存者（CCS）罹患慢性健康问题（包括肌肉骨骼疾病）的风险增加。关于维生素 D 缺乏症（VDD，<20ng/ml）及其与长期 CCS 骨矿物质密度（BMD）之间的关联，知之甚少。我们评估了在大型、多样化的长期 CCS 人群中 VDD 的患病率和危险因素，并检查了接受指南推荐的双能 X 射线吸收法（DXA）筛查的患者中 VDD 与 BMD 之间的关联。
本横断面研究纳入了 2018 年 3 月至 2020 年 9 月期间连续就诊的 446 名 CCS。单变量分析检查了 CCS 人口统计学、社会经济地位和治疗暴露与 VDD 之间的关联。多变量逻辑回归确定了与 VDD 和 BMD 降低几率相关的因素。
中位评估年龄为 27.5 岁（范围 7-67 岁）；中位完成治疗时间为 14.2 年（范围 2-65 年）。50%为女性，45%为西班牙裔。24%存在 VDD。在多变量分析中，超重和肥胖 BMI 与 VDD 相关（超重：OR 1.78，95%CI 1.03-3.07，p=0.04；肥胖：OR 2.40，95%CI 1.39-4.13，p<0.01；参考：正常/体重不足），西班牙裔或黑人种族/民族也是如此（OR 2.40，95%CI 1.41-4.09，p<0.01；参考：非西班牙裔白人）。在 118 名接受 DXA 结果的 CCS 中，VDD 与 BMD 降低独立相关（OR 3.58，95%CI 1.33-9.59，p=0.01）。
CCS 存在 VDD 的高患病率。高 BMI 和西班牙裔或黑人种族/民族与 VDD 相关。存在 VDD 的幸存者 BMD 降低的风险增加了三倍以上。基于风险的筛查可能有助于及时干预，以减轻 CCS 中的 VDD 并改善 BMD。
