Endocrine Abstracts

Introduction: Improved survival in childhood acute lymphoblastic leukaemia (ALL) has highlighted the importance of recognising and preventing skeletal morbidity. This study aims to assess bone health of ALL patients and compare this to other paediatric patients with chronic illness.

Methods: Dual energy absorptiometry (DXA) scan results for total body bone mineral density (TBBMD), lumbar spine bone mineral apparent density (LSBMAD) and total body less head (TBLH) were analysed for ALL patients referred between October 2008–August 2010. These were compared to scans from 141 children taken between May 2009–2010 and divided into nine subgroups by chronic disease. Bone profiles were reviewed if available.

Results: Patients with ALL made up 22 (13%) of total scans (n=163) with an age range of 4.8–17.8 years (92 males). 36% of the leukaemia patients (n=22) were referred following fractures. Of the ten comparison groups, patients with ALL had the second lowest mean (S.D.) TBBMD Z-score (−1.74, (1.54)), behind patients with metabolic pathway disorders (−1.86 (1.39)). ALL patients had the third lowest mean TBLH (−1.57 (1.49)), behind patients with metabolic pathway disorders (−2.02 (1.84)) and neurological conditions (−1.94 (1.02)), and third lowest LSBMAD (−1.43 (1.41)), behind patients with metabolic pathway disease (−1.88 S.D. 2.69) and bone disease (−1.64 (1.75)). Where results were available, 81% of patients with ALL (n=16) had vitamin D levels that were deficient or depleted (vitamin D ≤60 nmol/l).

Conclusion: Skeletal morbidity is likely to be multifactorial in patients with ALL and low bone density is evident when they are compared to patient groups with other chronic diseases, thus highlighting the need for a prospective observational study of bone health in this patient group.