Skip to main content
SpringerLink
Log in

Bone mineral density in survivors of childhood brain tumours

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Background

Osteopenia has been reported in children surviving acute lymphoblastic leukaemia, apparently as consequence of therapy. Few studies have been published on bone mineral density (BMD) evaluation in children surviving from brain tumours. The endocrine system in these patients is frequently affected as consequence of therapeutic interventions such as cranial irradiation and anti-neoplastic agents: growth hormone deficiency is the most common adverse sequel. The pathogenesis of osteopenia in brain cancer survivors is multi-factorial but still uncertain.

Objective

The aim of this study is to examine bone mass in 12 brain cancer survivors and its relationship with their hormonal status.

Results and discussion

We observed that most of the patients had a BMD that was lower than normal in both the lumbar column and in the femoral neck. Bone mass loss was higher in the lumbar region rather than in the femoral neck, due to spinal radiation therapy and to the effect of hormonal deficiencies. Particularly hypogonadism, but also multiple hormonal deficiencies, are associated with lower BMD values. Experience in clinical care of these patients suggests the importance of periodic evaluations of BMD, especially in those with secondary hormone deficiencies. Moreover, the periodic assessment of the hypothalamus–pituitary function is essential for an early diagnosis of hormonal insufficiency, primarily hypogonadism, to precociously detect bone mineral loss and to prevent pathological fractures, thus improving the quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Seeman E (2002) Pathogenesis of bone fragility in women and men. Lancet 359:1841–1850

    Article  PubMed  Google Scholar 

  2. Atkinson SA, Frasher L, Gundberg CM et al (1989) Mineral homeostasis and bone mass in children treated for acute lymphoblastic leukaemia. J Pediatr 114:793–800

    Article  PubMed  CAS  Google Scholar 

  3. Warner JT, Evans WD, Dunstan FDJ et al (1996) Relative osteopenia following treatment for childhood acute lymphoblastic leukemia. Med Pediatr Oncol 27:241, (Abstract O-119)

    Google Scholar 

  4. Hoorweg-Nijman JJG, van Dijk HJ, Pieters R et al (1996) Bone mineralization after treatment for acute lymphoblastic leukemia. Med Pediatr Oncol 27:292, (Abstract P20)

    Google Scholar 

  5. Halton JM, Atkinson SA, Fraher L et al (1996) Altered mineral metabolism and bone mass in children during treatment for acute lymphoblastic leukaemia. J Bone Miner Res 11:1774–1783

    PubMed  CAS  Google Scholar 

  6. Gilsanz V, Carlson ME, Roe TF et al (1990) Osteoporosis after cranial irradiation for acute lymphoblastic leukemia. J Pediatr 117:238–244

    Article  PubMed  CAS  Google Scholar 

  7. Brennan BMD, Rahim A, Mackie EM et al (1996) Osteopenia and growth hormone deficiency in adults treated for acute lymphoblastic leukemia in childhood. Med Pediatr Oncol 27:347, (Abstract P240)

    Google Scholar 

  8. Chihara K, Sugimoto T (1997) The action of GH/IGF-1/IGFBP in osteoblasts and osteoclasts. Horm Res 48(Suppl):45–49

    Article  PubMed  CAS  Google Scholar 

  9. Barr RD, Halton J, Cockshott WP et al (1993) Impact of age and cranial irradiation on radiographic skeletal pathology in children with acute lymphoblastic leukaemia. Med Pediatr Oncol 21:537 (Abstract 26)

    Google Scholar 

  10. Barr RD, Simpson T, Webber CE, Gill JC, Hay J, Eves M, Whitton AC (1998) Osteopenia in children surviving brain tumours. Eur J Cancer 34(6):873–877

    Article  PubMed  CAS  Google Scholar 

  11. Brennan BMD, Rahim A, Adams JA, Eden OB, Shalet SM (1999) Reduced bone mineral density in young adults following cure of acute lymphoblastic leukaemia in childhood. Br J Cancer 79:1859–1863

    Article  PubMed  CAS  Google Scholar 

  12. De Boer H, Block GJ, Van Lingen A, Teule GJJ, Lips P, Van der Veen EA (1994) The consequences of childhood onset of growth hormone deficiency for adult bone mass. J Bone Miner Res 9:1319–1326

    Article  PubMed  Google Scholar 

  13. Kaufmann JM, Tachman P, Vermeulen A, Vandeweghe M (1992) Bone mineral status in growth hormone deficient males with isolate and multiple pituitary deficiencies of childhood onset. J Clin Endocrinol Metab 74:118–123

    Article  Google Scholar 

  14. Holmes SJ, Economou G, Whitehouse RW, Adams JE, Chalet SS (1994) Reduced bone mineral density in patients with adult onset growth hormone deficiency. J Clin Endocrinol Metab 78:669–674

    Article  PubMed  CAS  Google Scholar 

  15. Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G, Faggiano A, Corneli G, Ghigo E, Lombardi G (1999) Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. J Clin Endocrinol Metab 84(6):1919–1924

    Article  PubMed  CAS  Google Scholar 

  16. Mulder JE, Bilezikian JP (2004) Bone density in survivors of childhood cancer. J Clin Densitom 7(4):432–442

    Article  PubMed  Google Scholar 

  17. Arikoski P, Komulainen J, Riikonen P et al (1999) Alterations in bone turnover and impaired development of bone mineral density in newly diagnosed children with cancer: a 1-year prospective study. J Clin Endocrinol Metab 84:3174–3181

    Article  PubMed  CAS  Google Scholar 

  18. Crofton PM, Ahmed SF, Wade JC et al (1998) Effects of intensive chemotherapy on bone and collagen turnover and the growth hormone axis in children with acute lymphoblastic leukaemia. J Clin Endocrinol Metab 83:3121–3129

    Article  PubMed  CAS  Google Scholar 

  19. Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 51:170–179

    Article  PubMed  CAS  Google Scholar 

  20. Arikoski P, Voutilainen R, Kroger H (2003) Bone mineral density in long-term survivors of childhood cancer. J Pediatr Endocrinol Metab 16(Suppl 2):343–353

    PubMed  Google Scholar 

  21. Liora L, Sivan D, Moshe P (2003) Growth without growth hormone: growth pattern and final height of five patients with idiopathic combined pituitary hormone deficiency. Clin Endocrinol 59:82–88

    Article  Google Scholar 

  22. Geffner ME (1996) The growth without growth hormone syndrome. Endocrinol Metab Clin N Am 25:649–663

    Article  CAS  Google Scholar 

  23. Murashita M, Tajima T, Nakae J, Shinohara N, Geffner ME, Fujieda K (1999) Near-normal linear growth in the setting of markedly reduced growth hormone and IGF1: a case report. Horm Res 51:184–188

    Article  PubMed  CAS  Google Scholar 

  24. Ashcraft MW, Hartzband PI, van Herle AJ, Bersch N, Golde DW (1983) A unique growth factor in patient with acromegaloidism. J Clin Endocrinol Metab 57:272–276

    Article  PubMed  CAS  Google Scholar 

  25. Fors H, Bjarnason R, Wiren L et al (2001) Currently used growth-promoting treatment of children results in normal bone mass and density. A prospective trial of discontinuing GH treatment in adolescents. Clin Endocrinol (Oxf) 55:617–624

    Article  CAS  Google Scholar 

  26. Murray RD, Darzy KH, Gleeson HK, Shalet SM (2002) GH-deficient survivors of childhood cancer: GH replacement during adult life. J Clin Endocrinol Metab 87(1):129–135

    Article  PubMed  Google Scholar 

  27. Behre HM, Kliesh S, Leifke E, Link TM, Nieschlag E (1997) Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab 82:2386–2390

    Article  PubMed  CAS  Google Scholar 

  28. Rosen T, Wilhelmsen L, Landin- Wilhelmsen K, Lappas G, Bengtsson BA (1997) Increased fracture frequency in adult patients with hypopituitarism and GH deficiency. Eur J Endocrinol 137:240–245

    Article  PubMed  CAS  Google Scholar 

  29. Balducci R, Toscano V, Pasquino AM et al (1995) Bone turnover and bone mineral density in young adult patients with panhypopituitarism before and after long-term growth hormone therapy. Eur J Endocrinol 132:42–46

    PubMed  CAS  Google Scholar 

  30. Hokken-Koelega ACS, van Doorn JWG, Hahlen K et al (1993) Long term effects of treatment for acute lymphoblastic leukemia with and without cranial irradiation on growth and puberty: a comparative study. Pediatr Res 33:577–582

    PubMed  CAS  Google Scholar 

  31. Wüster C (1993) Growth hormone and bone metabolism. Acta Endocrinol (Copenh) 128(Suppl 2):14–18

    Google Scholar 

  32. Inzucchi SE, Robbins RJ (1994) Effects of growth hormone on human biology. J Clin Endocrinol Metab 79:691–694

    Article  PubMed  CAS  Google Scholar 

  33. Mukherjee A, Shalet S (2003) Growth hormone replacement therapy (GHRT) in children and adolescents: skeletal impact. Med Pediatr Oncol 41:235–242

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, Università Cattolica del Sacro Cuore (UCSC), Rome, Italy

    M. Petraroli, E. D’Alessio, E. Ausili, R. Riccardi & A. Rossodivita

  2. Department of Clinical Biochemistry, Università Cattolica del Sacro Cuore (UCSC), Rome, Italy

    A. Barini

  3. Department of Internal Medicine, Università Cattolica del Sacro Cuore (UCSC), Rome, Italy

    P. Caradonna

  4. Section of Paediatric Neurosurgery, Department of Paediatrics, Università Cattolica del Sacro Cuore (UCSC), Rome, Italy

    M. Caldarelli

  5. Paediatric Department, Policlinico “A. Gemelli”, Largo “A. Gemelli”, 8, 00168, Rome, Italy

    A. Rossodivita

Authors
  1. M. Petraroli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. D’Alessio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Ausili
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Barini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Caradonna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Riccardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Caldarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Rossodivita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Rossodivita.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Petraroli, M., D’Alessio, E., Ausili, E. et al. Bone mineral density in survivors of childhood brain tumours. Childs Nerv Syst 23, 59–65 (2007). https://doi.org/10.1007/s00381-006-0175-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-006-0175-7

Keywords

Search

Navigation