medwireNews: More than a quarter of childhood cancer survivors have moderate or severe bone mineral density (BMD) deficits in adulthood, report US researchers who believe targeted interventions could reduce this burden.
“Findings of this study highlight the social, functional, and quality-of-life challenges survivors with BMD deficits persistently face”, say Kirsten Ness (St Jude Children’s Research Hospital, Memphis, Tennessee, USA) and co-authors in JAMA Network Open.
“[M]ost deficits observed were directly attributable to treatment exposures, comorbidities, smoking, and sedentary behavior”, they observe.
The study included 3919 participants of the St Jude Lifetime cohort who had survived for at least 5 years after receiving a childhood cancer diagnosis between 1962 and 2012. The survivors were aged a median 31.7 years, 52.6% were men and 80.4% were non-Hispanic White.
BMD was assessed at the lumbar vertebrae L1 and L2 and reported as age- and sex-specific z scores, where normal BMD was above 1 standard deviation (SD), moderate deficit BMD was less than or equal to –1 SD and severe deficit BMD was less than or equal to –2 SD.
Overall, moderate BMD deficits were identified in 21.7% of the patients and severe BMD deficits in 6.9%; men were significantly more likely than women to have moderate (27.1 vs 15.6%) and severe (8.8 vs 4.8%) BMD deficits.
Age 5–9 years at time of cancer diagnosis (versus younger or older age) and the type of cancer treatment received accounted for 18.5% of moderate and 55.4% of severe BMD deficits in the survivors, while comorbidity accounted for 10.2% and 51.1%, respectively, and smoking and sedentary lifestyle explained 7.0% and 9.9%.
For example, with regard to treatment exposure, severe deficits in BMD at the most recent evaluation were significantly predicted by receipt of 30 Gy or more cranial radiation (odds ratio [OR]=5.22 versus no cranial radiation) and receipt of any testicular or pelvic radiation (OR=1.70 vs none) but not by receipt of glucocorticoids or alkylating agents.
When considering comorbidity and lifestyle factors, severe deficits in BMD were significantly associated with a diagnosis of hypogonadism (OR=3.27) or growth hormone deficiency (OR=5.28), as well as with being underweight (BMI <18.5 kg/m2, OR=3.21), current smoking (OR=1.43) and sedentary behaviours (OR=2.06).
And after taking into account age, race/ethnicity, cancer treatment and other characteristics, survivors with moderate or severe BMD deficits were significantly less likely to live alone than those without (OR=0.76 and 0.47, respectively) and were significantly more likely to be unemployed (OR=0.79 and 0.65), and to require personal care assistance (OR=1.68 and 1.89).
People with any BMD deficits were also more likely than those without to have poor quality of life in terms of the ShortForm-36 subscales of bodily pain, physical and role function and general health, while those with moderate BMD were more likely to report poor quality of life on the social function, role emotion and mental health subscales.
“Survivors should be screened for BMD deficits during follow-up and counselled to optimize health behaviors to minimize progression of bone loss”, Ness et al therefore recommend.
“Appropriate counselling is particularly important for survivors as they enter adulthood, moving from pediatric to adult health care systems when primary care clinicians are largely responsible for managing their health care”, they emphasize, as is education for primary care clinicians who may be less familiar with “surveillance guidelines for this vulnerable population.”
The authors conclude: “In addition to further randomized clinical trials evaluating the efficacy of hormone and drug interventions, alone or in combination with lifestyle modifications, creative practical approaches to educate both survivors and clinicians are needed.”
By Lynda Williams
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2025 Springer Healthcare Ltd, part of the Springer Nature Group
