Abstract | BACKGROUND: Premature bone loss after childhood chemotherapy may be underestimated in patients with bone sarcoma. Methotrexate (MTX), a standard agent in osteosarcoma protocols, reportedly reduces bone mineral density (BMD). The literature, however, has reported cases of BMD reduction in patients with Ewing's sarcoma treated without MTX. Thus, it is unclear whether osteoporosis after chemotherapy relates to MTX or to other factors. QUESTIONS/PURPOSES: We therefore asked whether (1) young patients with a bone sarcoma had BMD reduction, (2) patients treated with MTX had lower BMD, and (3) other factors (eg, lactose intolerance or vitamin D deficiency) posed additional risks for low BMD. METHODS: We retrospectively reviewed 43 patients with malignancies who had dual-energy x-ray absorptiometry (DEXA) (lumbar, femoral); 18 with Ewing's sarcoma (mean age, 26 ± 8 years), and 25 with an osteosarcoma (mean age, 27 ± 10 years). The mean time since diagnosis was 8 ± 4 years in the group with Ewing's sarcoma and 7 ± 5 years in the group with osteosarcoma. At last followup we determined BMD (computing z-scores), fracture rate, and lifestyle, and performed serum analysis. RESULTS: BMD reduction was present in 58% of patients (37% had a z-score between -1 and -2 SD, 21% had a z-score less than -2 SD) in at least one measured site. Seven of the 43 patients (16%) had nontrauma or tumor-associated fractures after chemotherapy. Findings were similar in the Ewing and osteosarcoma subgroups. We found vitamin D deficiency in 38 patients (88%) and borderline elevated bone metabolism; lactose intolerance was present in 16 patients (37%). CONCLUSION: LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Authors | Ulrike Michaela Pirker-Frühauf, Jörg Friesenbichler, Ernst-Christian Urban, Barbara Obermayer-Pietsch, Andreas Leithner |
Journal | Clinical orthopaedics and related research
(Clin Orthop Relat Res)
Vol. 470
Issue 10
Pg. 2874-85
(Oct 2012)
ISSN: 1528-1132 [Electronic] United States |
PMID | 22806259
(Publication Type: Journal Article)
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Chemical References |
- Antimetabolites, Antineoplastic
- Methotrexate
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Topics |
- Adolescent
- Adult
- Antimetabolites, Antineoplastic
(adverse effects)
- Bone Density
(drug effects)
- Bone Neoplasms
(drug therapy)
- Child
- Female
- Humans
- Male
- Methotrexate
(adverse effects)
- Osteoporosis
(chemically induced)
- Osteosarcoma
(drug therapy)
- Retrospective Studies
- Time Factors
- Young Adult
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