Bone mineral density in adult survivors of childhood acute leukemia: impact of hematopoietic stem cell transplantation and other treatment modalities

Femoral and lumbar bone mineral densities (BMDs) were measured in 159 adults enrolled in the Leucemies de l'Enfant et de l'Adolescent program, a French prospective multicentric cohort of childhood leukemia survivors. BMDs were expressed as Z-scores, and multivariate linear regression analyses were used to construct association models with potential risk factors. Mean age at evaluation and follow-up was 23 and 14.7 years, respectively. In the whole cohort, mean femoral Z-score was -0.19 +/- 0.08. Two factors were associated with lower femoral BMD transplantation (-0.49 +/- 0.15 vs -0.04 +/- 0.10 in the chemotherapy group; P = .006) and female sex (-0.34 +/- 0.10 vs -0.03 +/- 0.13; P = .03). Among patients who received a transplant, the only significant risk factor was hypogonadism (-0.88 +/- 0.16 vs -0.10 +/- 0.23; P = .04). A slight reduction in lumbar BMD (mean Z-score, -0.37 +/- 0.08) was detected in the whole cohort without difference between the transplantation and chemotherapy groups. Among patients who received a transplant, younger age at transplantation was correlated with a low lumbar BMD (P = .03). We conclude that adults who had received only chemotherapy for childhood leukemia have a slight reduction in their lumbar BMD and a normal femoral BMD. Patients who received a transplant with gonadal deficiency have a reduced femoral BMD which might increase the fracture risk later in life. (Blood. 2011;118(6):1481-1489)