Risk and determinants of low and very low bone mineral density and fractures in a national cohort of Dutch adult childhood cancer survivors (DCCSS-LATER): a cross-sectional study
Authors' conclusion
Survivors of childhood cancer are at increased risk of any first fracture. Very low lumbar spine BMD was associated with fractures, highlighting the importance of active BMD surveillance in high-risk survivors (ie, those treated with cranial, craniospinal, or total body irradiation). Moreover, our results indicate that intensive surveillance and timely interventions for endocrine disorders and vitamin deficiencies might improve bone health in childhood cancer survivors, but this needs to be assessed in future studies.
Study context
- Population
- Dutch adult childhood cancer survivors aged 18–45 years, ≥5 years after diagnosis of childhood cancer before age 19, treated 1963–2002; mean age 33.1 years, 48.2% female
- Participants
- 2,003 survivors1,548 evaluable DXA scans
- Outcome
- Low (Z-score ≤−1) or very low (Z-score ≤−2) BMD by DXA, any fractures and vertebral fractures, and their risk factors
Methodological detailsnational cohort, DCCSS LATER cohort, seven Dutch paediatric oncology centres, Enrolled between April 29, 2016, and Jan 22, 2020; 2003 (50.1%) of 3996 invited
- National cohort
- DCCSS LATER cohort
- Seven Dutch paediatric oncology centres
- Enrolled between April 29, 2016, and Jan 22, 2020; 2003 (50.1%) of 3996 invited
Main finding
As reported in the abstract
- Low bone mineral density (BMD) at any site
- 559 (36.1%) of 1548
- Very low BMD at any site
- 149 (9.6%)
- Standardised incidence ratio of any first fracture, male participants
- 3.53 (95% CI 3.06-4.06)
- Standardised incidence ratio of any first fracture, female participants (4.46-6.52)
- 5.35
- Vertebral fractures
- 33 (13.3%) of 249
Observational data: associations, not effects.
Further findings
Risk factors (logistic regression)
- Associated with low BMD at any site: male sex, underweight, high carboplatin dose, any dose of cranial radiotherapy, hypogonadism, hyperthyroidism, low physical activity, severe vitamin D deficiency
- Associated with very low BMD at any site: male sex, underweight, cranial radiotherapy, GH deficiency, severe vitamin D deficiency
- Associated with any fractures: male sex, former and current smoking, very low lumbar spine BMD
- Associated with vertebral fractures: older age at follow-up, previous platinum compounds, GH deficiency, low physical activity
Original publication
Risk and determinants of low and very low bone mineral density and fractures in a national cohort of Dutch adult childhood cancer survivors (DCCSS-LATER): a cross-sectional study. Lancet Diabetes Endocrinol. Published 10 December 2022. doi:10.
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