Purpose or Case Report: Increased rates of survival of patients diagnosed with childhood cancer presents an opportunity to assess long-term effects of treatments. Bone health has been identified as one of the processes impacted by cancer treatment. Bone densitometry is a tool used for patients currently undergoing treatment for childhood cancer and hematologic diseases such as sickle cell disease and those having completed therapy. This discussion will focus on the methods used to measure bone health and some of the challenges involved in doing so.
Methods & Materials: Patients were scanned at prescribed intervals and/or time points using Quantitative Computed Tomography (QCT) lumbar spine and Dual Energy X-ray Absorptiometry (DXA) with results interpreted by radiologists and entered into the patients’ chart for clinician review. This presentation will include the basic physiology of bone remodeling and illustrate how QCT and DXA are utilized to measure bone health. Differences between the two modalities and challenges encountered in completing these studies will be discussed using data from previously published papers as well as drawing on personal experience with bone densitometry.
Results: It has been shown through these evaluations that bone health can be adversely affected by treatments for catastrophic diseases during a time when bone mineral accretion typically occurs in the healthy population. Patients most severely affected include those treated at a younger age, those receiving glucocorticoid treatment, endocrinopathies and craniospinal irradiation. Those at greatest risk include children treated for Acute Lymphoblastic Leukemia and brain tumors, Lifestyle factors such as suboptimal nutrition and limited weight-bearing exercise can compound the effects of therapy.
Conclusions: Bone densitometry is a valuable tool in the overall care of childhood cancer patients and those with hematologic diseases. Serial scanning at prescribed intervals aids in monitoring the status of bone health as patients age. Patients should be counseled on lifestyle choices including diet and exercise that may help to maintain or improve their bone health. Optimization of bone health is needed during adolescence and early adulthood in order to protect bone mineral density into adulthood.