Keele Research Repository

Background
Acute lymphoblastic leukemia (ALL) and its treatment are often implicated in adversely affecting bone health. Conflicting reports in the literature and a paucity of studies from the developing world prompted us to study bone mineral density (BMD) in childhood ALL survivors.

Methods
BMD lumbar spine (LS) and whole body (WB) were evaluated, using dual energy x‐ray absorptiometry in 65 pediatric ALL survivors who had been off‐therapy for at least 2 years. The control group constituted of 50 age‐ and sex‐matched healthy siblings. Kernel density plots were used to compare BMD among cases and controls. The disease‐, treatment‐, hormone‐ and lifestyle‐related factors likely to modulate BMD were analyzed using the Mann–Whitney U test and Student's t‐test.

Results
At a median of 4.3 years (range, 2–14.8 years) since cessation of therapy, height‐adjusted (HA) mean BMD Z‐scores of LS (−0.67 ± 1.11, −0.607 ± 1.05, P = 0.759) and WB (−0.842 ± 0.92, −0.513 ± 0.97, P = 0.627) were comparable among the cases and controls. Disease, treatment (chemotherapy, cranial radiotherapy) and endocrine factors did not predict low BMD. However, survivors with calcium intake <800 mg/day (WB, P = 0.018) and hypovitaminosis D (≤25 nmol/L) had lower BMD values (HA‐WB, P = 0.046) than the controls. A significant proportion of survivors were overweight or obese and had higher BMD Z‐scores (HA‐LS, P = 0.003; HA‐WB, P = 0.028).

Conclusion
BMD Z‐scores were similar among ALL survivors and controls. It was reassuring that there was no detrimental impact of the disease or its treatment on BMD. Future studies are required to determine the best possible ways to target the modifiable risk factors (diet, vitamin D) to optimize bone health.