Children with ALL Have High Incidence of Vertebral Fracture After 1 Year of Chemotherapy
Although vertebral fractures due to osteoporosis are a potential complication of childhood ALL, incidence of vertebral fractures during ALL treatment has not been reported, they noted.
They analyzed relevant clinical indices such as spine bone mineral density (BMD), back pain, and the presence of vertebral fractures at baseline for association with incident vertebral fractures. Lateral thoracolumbar spine radiographs, which were obtained at baseline and at 12 months.
Of 155 children with ALL evaluated during the first 12 months of treatment for their disease, 25 (16%) had a total of 61 incident vertebral fractures, of which 32 (52%) were moderate or severe. “Thirteen (52%) of the 25 children with incident vertebral fractures also had fractures at baseline,” they reported.
Presence of vertebral fractures at baseline was found to increase likelihood of an incident fracture at 12 months (OR 7.3 [95% CI, 2.3–23.1]; P=0.001). For every one standard deviation reduction in spine BMD Z-score at baseline, a 1.8-fold increased odds of incident vertebral fracture at 12 months (95% CI, 1.2–2.7; P=0.006) was observed.
“A key clinical question is whether children with ALL and vertebral fractures in the first year of therapy should be treated with osteoporosis agents such as bisphosphonates,” the authors wrote. “To date, there have been no randomized, placebo-controlled trials in pediatric ALL to provide adequate safety and efficacy data and thereby justify the use of such agents as standard of care.
Any future studies of osteoporosis treatment in pediatric ALL should “consider that the mechanisms underlying bone disease may be different early after disease presentation compared with later or even after completion of chemotherapy,” they concluded.