Aggravated bone density decline following symptomatic osteonecrosis in children with acute lymphoblastic leukemia
Marissa A.H. den Hoed,
Saskia M.F. Pluijm,
Mariël L. te Winkel,
Hester A. de Groot-Kruseman,
Martha Fiocco,
Peter Hoogerbrugge,
Jan A. Leeuw,
Marrie C.A. Bruin,
Inge M. van der Sluis,
Dorien Bresters,
Maarten H. Lequin,
Jan C. Roos,
Anjo J.P. Veerman,
Rob Pieters,
Marry M. van den Heuvel-Eibrink
Affiliations
Marissa A.H. den Hoed
Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands;Princess Maxima Center, Utrecht, The Netherlands
Saskia M.F. Pluijm
Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands;Princess Maxima Center, Utrecht, The Netherlands
Mariël L. te Winkel
Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
Hester A. de Groot-Kruseman
Dutch Childhood Oncology Group, The Hague, The Netherlands
Martha Fiocco
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Utrecht, The Netherlands
Peter Hoogerbrugge
Department of Pediatric Hemato-Oncology, Radboud University Medical Center Nijmegen, Utrecht, The Netherlands
Jan A. Leeuw
Dutch Childhood Oncology Group, The Hague, The Netherlands;Beatrix Children’s Hospital, University of Groningen, Utrecht, The Netherlands
Marrie C.A. Bruin
Dutch Childhood Oncology Group, The Hague, The Netherlands;University Medical Center, Utrecht, The Netherlands
Inge M. van der Sluis
Department of Pediatric Oncology/ Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
Dorien Bresters
Dutch Childhood Oncology Group, The Hague, The Netherlands;Leiden University Medical Center, Utrecht, The Netherlands
Maarten H. Lequin
Department of Radiology, University Medical Center, Utrecht, The Netherlands
Jan C. Roos
Vrije Universiteit Medical Center, Amsterdam, The Netherlands
Anjo J.P. Veerman
Dutch Childhood Oncology Group, The Hague, The Netherlands;Vrije Universiteit Medical Center, Amsterdam, The Netherlands
Rob Pieters
Princess Maxima Center, Utrecht, The Netherlands
Marry M. van den Heuvel-Eibrink
Dutch Childhood Oncology Group, The Hague, The Netherlands;Princess Maxima Center, Utrecht, The Netherlands
Osteonecrosis and decline of bone density are serious side effects during and after treatment of childhood acute lymphoblastic leukemia. It is unknown whether osteonecrosis and low bone density occur together in the same patients, or whether these two osteogenic side-effects can mutually influence each other’s development. Bone density and the incidence of symptomatic osteonecrosis were prospectively assessed in a national cohort of 466 patients with acute lymphoblastic leukemia (4–18 years of age) who were treated according to the dexamethasone-based Dutch Child Oncology Group-ALL9 protocol. Bone mineral density of the lumbar spine (BMDLS) (n=466) and of the total body (BMDTB) (n=106) was measured by dual X-ray absorptiometry. Bone density was expressed as age- and gender-matched standard deviation scores. Thirty patients (6.4%) suffered from symptomatic osteonecrosis. At baseline, BMDLS and BMDTB did not differ between patients who did or did not develop osteonecrosis. At cessation of treatment, patients with osteonecrosis had lower mean BMDLS and BMDTB than patients without osteonecrosis (respectively, with osteonecrosis: −2.16 versus without osteonecrosis: −1.21, P
