Modifiable risk factors associated with bone deficits in childhood cancer survivors

Cross-sectional study of bone health in 319 CCS and 208 healthy sibling controls. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). Generalized estimating equations were used to compare measures between CCS and controls. Among CCS, multivariable logistic regression was used to evaluate odds ratios for BMD Z-score ≤ -1.All subjects were younger than 18 years of age. Average time since treatment was 10.1 years (range 4.3 - 17.8 years). CCS were 3.3 times more likely to have whole body BMD Z-score ≤ -1 than controls (95% CI: 1.4-7.8; p = 0.007) and 1.7 times more likely to have lumbar spine BMD Z-score ≤ -1 than controls (95% CI: 1.0-2.7; p = 0.03). Among CCS, hypogonadism, lower lean body mass, higher daily television/computer screen time, lower physical activity, and higher inflammatory marker IL-6, increased the odds of having a BMD Z-score ≤ -1.CCS, less than 18 years of age, have bone deficits compared to a healthy control group. Sedentary lifestyle and inflammation may play a role in bone deficits in CCS. Counseling CCS and their caretakers on decreasing television/computer screen time and increasing activity may improve bone health.Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, resulting in an increased susceptibility to fracture [1]. Reduced bone mineral density (BMD) is a recognized condition among childhood cancer survivors (CCS). It is estimated that up to 46% of CCS less than 18 years old have reduced BMD [2-8]. Although children usually recover from fractures without any complication, fractures in adults have been shown to significantly increase both morbidity and mortality [9,10]. Importantly, the majority of bone accretion occurs in adolescence and young adulthood with peak bone mass reached by the second or third decade [11]. Treatment during adolescence interrupts this critical period of bone acquisition. A resultant decrease in peak bone mass would be ex