High incidence of vertebral fractures in children with acute lymphoblastic leukemia 12 months after the initiation of therapy

Authors

Nathalie Alos, University of Montreal
Ronald M. Grant, University of Toronto
Timothy Ramsay, Children's Hospital of Eastern Ontario, Ottawa
Jacqueline Halton, Children's Hospital of Eastern Ontario, Ottawa
Elizabeth A. Cummings, Dalhousie University
Paivi M. Miettunen, University of Calgary
Sharon Abish, Université McGill
Stephanie Atkinson, McMaster University
Ronald Barr, McMaster University
David A. Cabral, The University of British Columbia
Elizabeth Cairney, Western UniversityFollow
Robert Couch, University of Alberta
David B. Dix, The University of British Columbia
Conrad V. Fernandez, Dalhousie University
John Hay, Brock University
Sara Israels, University of Manitoba
Caroline Laverdier̀e, University of Montreal
Brian Lentle, The University of British Columbia
Victor Lewis, University of Calgary
Mary Ann Matzinger, Children's Hospital of Eastern Ontario, Ottawa
Celia Rodd, Université McGill
Nazih Shenouda, Children's Hospital of Eastern Ontario, Ottawa
Robert Stein, Western UniversityFollow
David Stephure, University of Calgary
Shayne Taback, University of Manitoba
Beverly Wilson, University of Alberta
Kathryn Williams, Children's Hospital of Eastern Ontario, Ottawa
Frank Rauch, Université McGill
Kerry Siminoski, University of Alberta

Document Type

Article

Publication Date

8-1-2012

Journal

Journal of Clinical Oncology

Volume

30

Issue

22

First Page

2760

Last Page

2767

URL with Digital Object Identifier

10.1200/JCO.2011.40.4830

Abstract

Purpose: Vertebral fractures due to osteoporosis are a potential complication of childhood acute lymphoblastic leukemia (ALL). To date, the incidence of vertebral fractures during ALL treatment has not been reported. Patient and Methods: We prospectively evaluated 155 children with ALL during the first 12 months of leukemia therapy. Lateral thoracolumbar spine radiographs were obtained at baseline and 12 months. Vertebral bodies were assessed for incident vertebral fractures using the Genant semiquantitative method, and relevant clinical indices such as spine bone mineral density (BMD), back pain, and the presence of vertebral fractures at baseline were analyzed for association with incident vertebral fractures. Results: Of the 155 children, 25 (16%; 95% CI, 11% to 23%) had a total of 61 incident vertebral fractures, of which 32 (52%) were moderate or severe. Thirteen (52%) of the 25 children with incident vertebral fractures also had fractures at baseline. Vertebral fractures at baseline increased the odds of an incident fracture at 12 months by an odds ratio of 7.3 (95% CI, 2.3 to 23.1; P = .001). In addition, for every one standard deviation reduction in spine BMD Z-score at baseline, there was 1.8-fold increased odds of incident vertebral fracture at 12 months (95% CI, 1.2 to 2.7; P = .006). Conclusion: Children with ALL have a high incidence of vertebral fractures after 12 months of chemotherapy, and the presence of vertebral fractures and reductions in spine BMD Z-scores at baseline are highly associated clinical features. © 2012 by American Society of Clinical Oncology.