Endocrine Abstracts

Introduction: Osteonecrosis is an increasingly common complication in young people treated for acute lymphoblastic leukaemia (ALL). This is likely to be due to the now universal use of high dose steroids.

Aim: The aim of this study was to obtain information on prevalence, current UK management and long-term outcomes of patients.

Methods: We retrospectively collated data on patients with osteonecrosis for the most recently completed trial for children and young adults with ALL, UKALL2003, which recruited 3126 patients aged between 1 and 24 years. A questionnaire was sent to all participating centres. Patients with reported bone toxicity were previously identified by the central trial unit, and patients details were sent to each centre. Information regarding previously unreported patients with osteonecrosis was also requested.

Results: Data regarding 144 patients with osteonecrosis were received. The overall prevalence of osteonecrosis was 5% in children and young people with ALL, with the majority (75%) aged between 10 and 16 years. 86% had multifocal osteonecrosis, with a total of 415 areas affected. The most commonly affected joints were hips (144), followed by knees (126) and shoulders (57). Osteonecrosis was diagnosed by MRI in 71% of cases. Steroids were stopped in 61% of patients. Bisphosphonates were used in 32 patients, of whom nine had a history of fractures. 57 patients required surgery, with 27 patients requiring one or both hips replaced. After a median follow up of 70 months, 53 patients were reported to have no long-term effects, 56 had minimal disability, 15 had significant disability and five required a wheelchair. Nine patients died, and outcome data was not available for 8 patients.

Conclusion: Osteonecrosis is a significant problem for patients with ALL, with a large percentage of those affected requiring surgery. A uniform management strategy is required, including guidelines for use of bisphosphonates and continuation of steroid therapy.