Adult survivors of haematological malignancies with premature ovarian failure (POF) secondary to multimodality cancer therapy have normal bone mass
S Clay, E Ward, G Cook & RD Murray
Adult survivors of haematological malignancies are subject to a number of putative insults to the skeleton. Adverse impacts on bone mass include sex-hormone deficiency, radiotherapy, chemotherapy, inadequate nutrition and a generalised catabolic state. We assessed BMD using DXA at the lumbar spine (LS) and femoral neck (FN) in 34 women with POF, defined by secondary amenorrhoea, elevated gonadotropins, and low oestradiol levels. Mean age at diagnosis was 29.7 (range 1445) years and mean weight 65.6+/−13.0 kg. Primary diagnoses were acute myeloid leukaemia (n=13), chronic myeloid leukaemia (n=9), acute lymphoblastic leukaemia (n=5), non-Hodgkins lymphoma (n=4), and Hodgkins Disease (n=3). Twenty of the 34 women received total body irradiation, 4 mediastinal irradiation, and 10 no radiotherapy. None of the women received pelvic irradiation. Patients who previously received bisphosphonate therapy were excluded.
Mean age at amenorrhoea was 30.7 (range 16-45) years. BMD was quantified a mean of 38.1 (range 2198) months after the onset of amenorrhoea. Z-scores at the LS and FN ranged from −2.8 to +1.0 (mean −0.35+/−1.08, P=0.34) and −2.1 to 1.1 (mean −0.50+/−1.04, P=0.41) respectively, and were not significantly different to the reference population. Five women (15%) had subnormal BMD as defined by a Z-score <−2.0. Three of these values occurred at the LS and two at the FN, none of the women had subnormal Z-score at both sites. Fourteen of the cohort were on oestrogen at the time of assessment. Analysis of the 20 patients who were not receiving oestrogen showed mean Z-scores at the LS and FN of −0.38 (range −2.8 to 1.2) and −0.22 (range −2.1 to 1.9) respectively. Four of the five patients with BMD values <−2.0 were not on oestrogen replacement.
We have shown BMD to be well preserved in the majority of women who receive multi-modality cancer therapy to induce remission of haematological malignancies.