Rapid bone loss 23 years after diagnosis for childhood acute lymfoblastic leukaemia (ALL) in spite of GH therapy
Cecilia Follin, Katarina Link, Thomas Wiebe, Christian Moëll, Jonas Björk & Eva Marie Erfurth
Context: Acute lymphoblastic leukaemia (ALL) is the most common pediatric malignancy and its treatment includes many known risk factors for low bone mineral density (BMD), e.g. glucocorticosteroids, methotrexat and cranial radiotherapy (CRT).
Objective: To evaluate bone mineral density (BMD) and markers of bone turn over in a group of adults with childhood onset ALL, treated with CRT and to evaluate the effect of 5 years with, and 8 years without GH therapy on BMD.
Material and methods: In 44 ALL patients (21 women), aged 25 years (1931 years) we evaluated BMD with DXA. Patients were GHD (91%) or insufficient. Comparisons were made with population controls, matched for age, gender, smoking and residence. Two subgroups of patients and matched controls were investigated with DXA at baseline and after 5 years with GH therapy (n=15; GH dose 0.5 mg/day)) and after 8 years without (n=13).
Results: At baseline no significant differences in BMD or Z-scores at femoral neck or L2L4 or in levels of osteocalcin and crosslaps (all P>0.3) were recorded, between 44 ALL patients and controls. After GH therapy in 15 ALL patients there was a non-significant decline in BMD and Z-scores but without difference in these levels compared to controls after 5 years. Among the 13 untreated GHD ALL patients BMD at femoral neck and Z-scores (0.0 vs −0.5 SDS; P<0.05) together with osteocalcin and crosslaps decreased significantly after 8 years compared to baseline levels, and became significantly lower than matched controls after 8 years (−0.5 vs 0.4 SDS; P=0.05).
Conclusions: At the age of 25 years and 17 years after treatment for ALL, normal BMD and Z-scores at femoral neck and L2L4 was recorded. After another 58 years, there was a rather rapid decrease in Z-scores, irrespective of a moderate dose of GH therapy.