Attributable Risk and Consequences of Bone Mineral Density Deficits in Childhood Cancer Survivors
Authors' conclusion
While treatment exposures were associated with long-term BMD deficits, modifiable risk factors, including smoking, sedentary behavior, hypogonadism, and growth hormone deficiency, suggest feasible targets for intervention.
Study context
- Population
- Adult survivors of childhood cancer diagnosed 1962–2012 and surviving ≥5 years from diagnosis, St Jude Lifetime (SJLIFE) cohort; median age 31.7 years, 52.6% male
- Participants
- 3,919 five-year survivors
- Outcome
- Moderate (z score ≤−1 SD) or severe (≤−2 SD) BMD deficits by lumbar quantitative CT; Odds ratios (ORs), attributable fractions (AFs) and associations with long-term sequelae (social, functional, QOL)
Methodological detailsretrospectively constructed cohort with prospective follow-up, cross-sectional and longitudinal data, Data collected November 2007 to June 2020; analyzed January 2021 to November 2023
- Retrospectively constructed cohort with prospective follow-up
- Cross-sectional and longitudinal data
- Data collected November 2007 to June 2020; analyzed January 2021 to November 2023
Main finding
As reported in the abstract
Moderate bone mineral density (BMD) deficit prevalence
21.7%
95% CI 20.4%–23.0%
Severe BMD deficit prevalence
6.9%
95% CI 6.1%–7.7%
Moderate deficits explained by treatment exposures (incl. age at diagnosis), comorbid conditions, and smoking and sedentary behavior, respectively
18.5%, 10.2%, 7.0%
Severe deficits explained by treatment exposures (incl. age at diagnosis), comorbid conditions, and smoking and sedentary behavior, respectively
55.4%, 51.1%, 9.9%
Observational data: associations, not effects.
Further findings
Risk factors for severe BMD deficits
| OR (95% CI) | ||
|---|---|---|
| CRT ≥30 GyAF, 33.0% | 5.22 (3.74–7.30) | |
| Testicular or pelvic radiationAF, 11.5% | 1.70 (1.19–2.44) | |
| HypogonadismAF, 25.1% | 3.27 (2.35–4.55) | |
| GHDAF, 26.0% | 5.28 (3.68–7.56) | |
| SmokingAF, 6.7% | 1.71 (1.21–2.43) | |
| Sedentary behaviorAF, 6.2% | 2.06 (1.15–3.69) | |
| 0.10.31310Odds ratio (log scale) |
Declining BMD
| OR (95% CI) | ||
|---|---|---|
| CRT exposureAF, 8.8% | 2.94 (1.46–5.91) | |
| 0.20.5125Odds ratio (log scale) |
Long-term consequences of BMD deficits
- Survivors with deficits were less likely to live alone and to be employed and more likely to require personal care assistance and to report depressive symptoms and poor QOL
Original publication
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