scholarly journals Longitudinal Assessment of Bone Density and Structure in Childhood Survivors of Acute Lymphoblastic Leukemia without Cranial Radiation

2012 ◽  
Vol 97 (10) ◽  
pp. 3584-3592 ◽  
Author(s):  
Sogol Mostoufi-Moab ◽  
Jill Brodsky ◽  
Elizabeth J. Isaacoff ◽  
Anne Tsampalieros ◽  
Jill P. Ginsberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Quantitative Computed Tomography ◽  
Peripheral Quantitative Computed Tomography ◽  
Longitudinal Assessment ◽  
Linear Regression Models ◽  
Mineral Density ◽  
Z Scores ◽  
Childhood Survivors

Abstract Purpose: Children with acute lymphoblastic leukemia (ALL) are at risk for impaired bone accrual. This peripheral quantitative computed tomography study assessed changes in bone mineral density (BMD) and structure after completion of ALL treatment. Methods: Fifty ALL participants, ages 5–22 yr, were enrolled within 2 yr (median 0.8 yr) after completing ALL therapy. Tibia peripheral quantitative computed tomography scans were performed at enrollment and 12 months later. Age-, sex-, and race-specific Z-scores for trabecular BMD (TrabBMD), cortical BMD (CortBMD), and cortical area (CortArea) were generated based on more than 650 reference participants. Multivariable linear regression models examined determinants of changes in Z-scores. Results: At enrollment, mean TrabBMD (−1.03 ± 1.34) and CortBMD (−0.84 ± 1.05) Z-scores were low (both P < 0.001) compared with reference participants. TrabBMD and CortBMD Z-scores increased to −0.58 ± 1.41 and −0.51 ± 0.91 over 1 yr, respectively (both P < 0.001). Changes in cortical outcomes varied according to the interval since completion of therapy. Among those enrolled less than 6 months after therapy, CortArea Z-scores increased and CortBMD Z-scores decreased (both P < 0.01). Among those enrolled 6 months or more after therapy, CortArea Z-scores did not change and CortBMD Z-scores increased (P < 0.01). Changes in CortArea and CortBMD Z-scores were inversely associated (r = −0.32, P < 0.001). Cumulative glucocorticoid exposure, leukemia risk status, and antimetabolite chemotherapy were not associated with outcomes. Conclusion: TrabBMD was low after completion of ALL therapy and improved significantly. Early increases in cortical dimensions were associated with declines in CortBMD; however, participants further from ALL therapy demonstrated stable cortical dimensions and increases in CortBMD, potentially reflecting the time necessary to mineralize newly formed bone.

CRHR1 Polymorphisms Predict Bone Density in Survivors of Acute Lymphoblastic Leukemia

2008 ◽  
Vol 26 (18) ◽  
pp. 3031-3037 ◽  
Author(s):  
Terreia S. Jones ◽  
Sue C. Kaste ◽  
Wei Liu ◽  
Cheng Cheng ◽  
Wenjian Yang ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Bone Density ◽  
Bone Mineral ◽  
Lymphoblastic Leukemia ◽  
Quantitative Computed Tomography ◽  
Nucleotide Polymorphisms ◽  
Mineral Density ◽  
Specific Manner ◽  
Osteoporosis Risk Factors ◽  
Z Scores

Purpose Corticosteroids are a critical component of therapy for acute lymphoblastic leukemia (ALL) but are associated with late effects, such as osteoporosis. Risk factors remain poorly defined. Because CRHR1 polymorphisms have been associated with other corticosteroid effects, our goal was to define whether CRHR1 polymorphisms predict which patients with ALL are likely to develop bone mineral deficits. Patients and Methods The mean bone mineral density z scores of 309 long-term survivors of ALL were determined by quantitative computed tomography of the trabecular lumbar spine. We analyzed whether CRHR1 genotypes, adjusted for sex, ALL treatment regimen, and weight, could predict bone density. Results We found that three single nucleotide polymorphisms (SNPs), all in linkage disequilibrium, were associated with bone density in a sex-specific manner. Bone density was lower in males (P = .001), in nonblack patients (P < .08), in those who were not overweight (P < .001), and in those who received intensive antimetabolites and glucocorticoids (P < .001). After adjustment for these features, the G allele at the rs1876828 SNP was associated with lower z scores (P = .02) in males but tended to have the opposite association in females (P = .09). Conclusion CRHR1 polymorphisms may impact the risk of bone density deficits in patients treated with corticosteroids and antimetabolites in a sex-specific manner.

scholarly journals Bone health in long-term survivors of acute lymphoblastic leukemia in children and ado-lecents. An assessment by peripheral quantitative computed tomography

2021 ◽  
Author(s):  
Ronald Barr ◽  
Dean Inglis ◽  
Uma Athale ◽  
Maciej Jaworski ◽  
Troy Farncombe ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Lymphoblastic Leukemia ◽  
Trabecular Bone ◽  
Cortical Bone ◽  
Bone Health ◽  
Lymphoblastic Leukemia ◽  
Quantitative Computed Tomography ◽  
Peripheral Quantitative Computed Tomography ◽  
Long Term Survivors

Background – Loss of bone mineral is a common concomitant of the treatment of acute lymphoblastic leukemia (ALL) due mainly to chemotherapy, especially with corticosteroids. Osteopenia/osteoporosis may persist long into survivorship. Measurement of bone mineral density (BMD) by dual energy X-ray absorptiometry is limited to two-dimensionality and cannot distinguish trabecular from cortical bone. Methods – A sample of 74 subjects, more than 10 years from diagnosis, underwent peripheral quantitative computed tomography (pQCT) at metaphyseal (trabecular bone) and diaphyseal (cortical bone) sites in the radius and tibia. pQCT provides three-dimensional assessment of bone geometry, density and architecture. Results – Similarities of average values in multiple metrics with those in healthy subjects obscured deficits in both trabecular and cortical bone, as well as bone strength, revealed by Z scores using an ethnically comparable sample of healthy individuals. Connectivity, a measure of bone architecture and a surrogate measure of bone strength, was lower in females than males. Survivors of standard risk ALL had greater connectivity in and more compact trabecular bone than high risk survivors who had received more intensive osteotoxic chemotherapy. There were no statistically significant differences in any of the metrics at any of the sites between subjects who had or had not a history of fracture, cranial irradiation or use of a bisphosphonate. Conclusions – These long-term survivors of ALL have somehat compromised bone health, but data in comparable healthy populations are limited. Longitudinal studies in larger and more ethnically diverse cohorts will provide greater insight into bone health in this vulnerable population.

Effect of Rheumatoid Arthritis on Volumetric Bone Mineral Density and Bone Geometry, Assessed by Peripheral Quantitative Computed Tomography in Postmenopausal Women Treated with Bisphosphonates

2012 ◽  
Vol 39 (6) ◽  
pp. 1215-1220 ◽  
Author(s):  
SYMEON TOURNIS ◽  
VASILIOS SAMDANIS ◽  
SAVAS PSARELIS ◽  
CHRYSA LIAKOU ◽  
JULIA ANTONIOU ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Quantitative Computed Tomography ◽  
Bone Geometry ◽  
Peripheral Quantitative Computed Tomography ◽  
Volumetric Bone Mineral Density ◽  
Mineral Density

Objective.To investigate the effect of rheumatoid arthritis (RA) on volumetric bone mineral density (vBMD) and bone geometry in postmenopausal women treated with bisphosphonates.Methods.Fifty-three postmenopausal women with RA and 87 control subjects, comparable in terms of age, body mass index, and years since menopause, underwent peripheral quantitative computed tomography (pQCT) of the nondominant tibia.Results.At 4% (trabecular site), trabecular bone mineral content (BMC) and vBMD (p < 0.001) were lower in the RA group, while trabecular area was comparable. At 38% (cortical site), cortical BMC (p < 0.01), area (p < 0.05), and thickness (p < 0.001) were lower in the RA group, whereas vBMD was comparable. Endosteal circumference was higher (p < 0.05), whereas periosteal circumference was comparable, indicating cancellization of cortical bone. In the RA group, muscle area was lower (p < 0.001), while at 14% polar stress strength index was significantly lower (p < 0.01) in patients with RA, indicating impairment of bone mechanical properties.Conclusion.RA is associated with negative effects on both cortical and cancellous bone in postmenopausal women treated with bisphosphonates. Cortical geometric properties are also adversely affected mainly by increased endosteal circumference, whereas trabecular geometric properties are generally preserved.

Bone Evaluation by High-Resolution Peripheral Quantitative Computed Tomography in Patients With Adrenal Incidentaloma

2020 ◽  
Vol 105 (8) ◽  
pp. e2726-e2737
Author(s):  
Aline Barbosa Moraes ◽  
Marcela Pessoa de Paula ◽  
Francisco de Paula Paranhos-Neto ◽  
Emanuela Mello Ribeiro Cavalari ◽  
Felipe Fernandes Cordeiro de Morais ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
High Resolution ◽  
Distal Radius ◽  
Bone Mineral ◽  
Quantitative Computed Tomography ◽  
Adrenal Incidentaloma ◽  
Peripheral Quantitative Computed Tomography ◽  
Mineral Density ◽  
X Ray

Abstract Context Data regarding high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with adrenal incidentaloma (AI) are unknown. Purpose To evaluate the areal bone mineral density (aBMD), microstructure, and fractures in patients with nonfunctioning AI (NFAI) and autonomous cortisol secretion (ACS). Methods We evaluated 45 patients with NFAI (1 mg dexamethasone suppression test [DST] ≤1.8 µg/dL) and 30 patients with ACS (1 mg DST 1.9-5.0 µg/dL). aBMD was measured using dual-energy X-ray absorptiometry; vertebral fracture by spine X-ray; and bone geometry, volumetric bone mineral density (vBMD), and microstructure by HR-pQCT. Results Patients with ACS showed lower aBMD values at the spine, femoral neck, and radius 33% than those with NFAI. Osteoporosis was frequent in both groups: NFAI (64.9%) and ACS (75%). Parameters at the distal radius by HR-pQCT were decreased in patients with ACS compared to those with NFAI: trabecular vBMD (Tb.vBMD, P = 0.03), inner zone of the trabecular region (Inn.Tb.vBMD, P = 0.01), the bone volume/tissue volume ratio (BV/TV, P = 0.03) and trabecular thickness (P = 0.04). As consequence, a higher ratio of the outer zone of the trabecular region/inner zone vBMD (Meta/Inn.vBMD, P = 0.003) was observed. A correlation between the cortisol levels after 1 mg DST and Meta/Inn.vBMD ratio was found (r = 0.29; P = 0.01). The fracture frequency was 73.7% in patients with ACS vs 55.6% in patients with NFAI (P = 0.24). Conclusion Our findings point to an association between trabecular bone microarchitectural derangement at the distal radius and ACS. Our data suggest that AI have a negative impact on bone when assessed by HR-pQCT, probably associated to subclinical hypercortisolism.

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