Send to

Choose Destination
Cancer. 2019 Sep 19. doi: 10.1002/cncr.32512. [Epub ahead of print]

Severity of reduced bone mineral density and risk of fractures in long-term survivors of childhood leukemia and lymphoma undergoing guideline-recommended surveillance for bone health.

Author information

Department of Pediatrics (Hematology-Oncology), Yale School of Medicine, New Haven, Connecticut.
Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
Seattle Children's Hospital, University of Washington, Seattle, Washington.
Department of Pediatrics (Endocrinology), Yale School of Medicine, New Haven, Connecticut.
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Yale Cancer Center, New Haven, Connecticut.



Survivors of childhood leukemia/lymphoma are at increased risk for reduced bone mineral density (BMD). The authors sought to determine the frequency of reduced BMD detected by off-therapy surveillance, factors associated with reduced BMD, and the association of reduced BMD with fractures.


This cross-sectional study included childhood leukemia/lymphoma survivors attending 2 survivorship clinics who received guideline-recommended BMD surveillance ≥2 years post-therapy with dual-energy x-ray absorptiometry (from January 1, 2004 to August 31, 2016). Lumbar spine BMD z-scores were height-for-age-adjusted. Low and very low BMD were >1 SD and >2 SDs below norms, respectively. Treatment, chronic conditions, and fractures were abstracted from medical records. Logistic regression was used to examine the association of low BMD with patient/treatment factors and fractures.


In total, 542 patients (51.5% female) with a mean age of 15.5 years (range, 4.4-52.2 years) who were 6 years post-therapy (range, 2.0-35.1 years) were evaluated, including 116 who reported post-therapy fractures. Lumbar spine low BMD was identified in 17.2% of survivors, and very low BMD was identified in 3.5% of survivors, but frequencies varied considerably between subgroups; 10.8% of survivors aged 15 to 19 years at diagnosis had very low BMD. In multivariable analyses, older age at diagnosis, white race, and being underweight were significantly associated with low BMD. Survivors with low BMD had greater odds of nondigit fractures (odds ratio, 2.2; 95% CI, 1.3-3.7) and specifically long-bone fractures (odds ratio, 2.7; 95% CI, 1.5-4.7).


In this study of childhood leukemia/lymphoma survivors undergoing guideline-recommended dual-energy x-ray absorptiometry surveillance, patients who were older at diagnosis, white, and underweight were at the highest risk for lumbar spine low BMD. Low BMD was associated with a greater risk of fractures, emphasizing the clinical importance of surveillance.


bone mineral density; cancer survivors; childhood cancer; dual-energy x-ray absorptiometry (DXA) scan; fractures; leukemia; lymphoma


Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center