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Risk Factors for Decreased Bone Mineral Density in Survivors of Childhood Cancer

GregoryAuneby Gregory Aune, MD, PhD, CKN Editor


Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood.  Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families.  Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship.  His goal is simple:  to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.


THE HEADLINE:  Survivors of Childhood Cancer at Risk for Decreased Bone Density

THE RESEARCH: Pediatric Blood and Cancer: Risk factors and surveillance for reduced bone mineral density in pediatric cancer survivors.  Between 2003 and 2010, 475 survivors of childhood leukemia and solid tumors (excluding central nervous system tumors) were screened for decreased bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA).  These screenings were conducted according to the consensus-based Children’s Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines.   Current guidelines recommend DXA testing in survivors who have received treatment with steroids, methotrexate, or hematopoietic stem cell transplant (HSCT). The primary goal of the study was to assess the yield of detecting decreased BMD in a contemporary cohort of childhood cancer survivors.

KEY FINDINGS:  For this assessed population, the mean Z-score for DXA scan was -0.1 for both lumbar spine and whole body measurements.  Among at-risk survivors, 8.2% had decreased BMD.  Multivariate analysis revealed that all of the following were associated with a higher risk of decreased bone mineralization:  total body irradiation, cranial irradiation, craniospinal irradiation, male gender, and gonadal dysfunction.  Methotrexate exposure was not clearly associated with decreased BMD.  Interestingly, those patients with a history of HSCT had a mildly decreased risk of developing decreased BMD compared to others within the cohort.

WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS:  As noted in last week’s post, endocrine disorders such as diabetes and obesity are frequently found in the growing population of childhood cancer survivors.  Moreover, there is a growing body of emerging evidence that is beginning to establish an unequivocal link between exposure to childhood cancer therapies and an increased long-term risk of developing endocrinopathies.  Decreased BMD is an important marker of abnormal bone metabolism and is likely an additional important harbinger of later health problems associated with poor bone health and quite possibly abnormal metabolism overall.  In this study, the survivors evaluated were relatively young and it is therefore important to continue research that will establish how BMD changes throughout the lifespan following successful childhood cancer therapy. It is imperative that survivors focus on maintaining bone health through previously established strategies, which include adequate daily calcium intake and physical activity.  As is the case with all late effects, ongoing monitoring is essential to identify developing problems with bone health and intervene when necessary.



Medical Disclaimer:  The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.



Videos with Dr. Aune

Presentation on YouTube (Jan 2015):  Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD

Interview for the National Coalition for Cancer Survivorship (June 2015):  Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care

Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends



Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar.  His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy.  His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma.  While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens.  His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies.  This life-changing event initiated his research interest in cardiac disease.  His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.

Dr. Aune is a national leader in childhood cancer advocacy efforts.  In San Antonio, he has been a leader in local fundraising and awareness efforts.   Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts.  In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.

In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.

In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.



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