Bone health

Advances in the treatment of children and adolescents with cancer; have led to substantial improvements in survival, with a 5-year survival rate of childhood cancer close to 80%. However, treatments such as chemotherapy and radiation can have long-term effects on bone health; potentially impacting on the attainment of peak bone mass, predisposing to premature onset of low bone mineral density.

A new publication by the International Osteoporosis Foundation (IOF) Cancer and Bone Working Group reviews the latest knowledge in this area of clinical research; and provides succinct recommendations for essential long-term follow-up of bone health in childhood cancer survivors.

Bone health in childhood cancer

However, the review ‘Bone health in childhood cancer: review of the literature and recommendations for the management of bone health in childhood cancer survivors’ aims; to help clinicians define specific groups at higher risk of long-term bone complications, identify unrecognized long-term adverse effects; and ultimately improve patient care. It includes a concise diagnostic-therapeutic algorithm which outlines a clinical pathway to aid physicians; in the long-term care of their patients.

Professor Maria-Luisa Brandi, Head of the Bone Metabolic Diseases Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Italy, and lead author of the study, states: “In children and adolescents treated for cancer; the attainment of peak bone mass, which is a fundamental factor affecting bone mass in adulthood; can be negatively affected.

Lower bone mineral density and microarchitectural deterioration; can persist during adulthood, thereby increasing fracture risk. That is why the bone health of children and adolescents with a cancer history should be carefully monitored, and patients should be informed of possible late complications of their previous medical treatment.”

Stem-cell transplantation

As well as cancer treatments such as chemotherapy, radiotherapy and stem-cell transplantation; factors which contribute to bone mass impairment in childhood cancer survivors; include an inadequate diet (especially calcium and vitamin D deficiency); prolonged treatments with glucocorticoids; hormone alterations involving growth hormone and/or gonadal hormones; reduced or absent physical activity; and inflammation and altered secretion of cytokines due to cancer cells.

The review also points to areas where there are substantial knowledge gaps; and identifies the need for further research to clarify whether improving bone health in childhood cancer survivors; differs from the management of bone disorders in the general population.

Professor René Rizzoli, added: “Cancer treatments in youth have a multifactorial impact on bone fragility and a core objective, both during treatment and once the patient is in remission or cured; is to reduce the impact on future adult bone health. This requires long-term follow up, involving effective transition from pediatric to adult care; as well as good communication between pediatric oncology and primary care. As clinicians we must work together to help to maintain and protect our young patients’ skeletal health.”