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Changes in pediatric DXA measures of musculoskeletal outcomes and correlation with quantitative CT following treatment of acute lymphoblastic leukemia.
Bone. 2018 07; 112:128-135.BONE

Abstract

We previously reported significant gains in pQCT measures of tibia trabecular bone mineral density (BMD) and cortical structure following completion of therapy in children and adolescents with acute lymphoblastic leukemia (ALL). The objective of this study was to examine changes in DXA measures used in clinical practice and expressed as Z-scores using robust national reference data. Children and adolescents, ages 5 to 18 years were enrolled within 2 (median 0.8) years of completing ALL therapy. DXA total-body less-head bone mineral content (TBLH-BMC), and spine, total hip, femoral neck, and 1/3rd radius areal BMD (aBMD) were assessed in 45 participants at enrollment and 12-months later. Linear regression models examined correlates of changes in DXA Z-scores. Changes in DXA outcomes were compared to changes in tibia pQCT trabecular and cortical volumetric BMD (vBMD) and cortical area. At enrollment, DXA TBLH-BMC, spine and radius aBMD Z-scores were not significantly reduced in ALL survivors; however, total hip [median -0.74 (IQ range -1.51 to -0.04)] and femoral neck [-0.51 (-1.24 to 0.14)] aBMD Z-scores were lower (both p < 0.01) compared to reference data. DXA Z-scores at all skeletal sites increased over 12 months. Despite improvement, total hip Z-score remained lower at -0.55 (-1.05 to 0.18). The increases in TBLH-BMC, total hip and femoral neck aBMD Z-scores were more pronounced in those enrolled within 6 months of completing ALL therapy, compared to those enrolled at >6 months. Gains in TBLH-BMC, total hip, femoral neck and radius aBMD Z-scores were significantly associated with gains in tibia cortical area Z-scores (R = 0.56 to 0.67, p ≤ 0.001). Changes in TBLH and proximal femur sites were associated with gains in trabecular vBMD Z-scores (R = 0.37 to 0.40; p ≤ 0.01); these associations were not significant when adjusted for gains in cortical area. In summary, gains in DXA measures were most pronounced in total hip and femoral neck following ALL therapy. The gains in all DXA measures, with the exception of lumbar spine, reflected gains in cortical area. Overall, ALL survivors demonstrate skeletal recovery following completion of therapy; a small sub-group continue to demonstrate deficits and benefit from continued observation to ensure improvement over time.

Authors+Show Affiliations

Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States. Electronic address: moab@email.chop.edu.Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.Department of Medicine, Perelman School of Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.Care-Mount Medical, Poughkeepsie, NY 12601, United States.Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States.Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29679731

Citation

Mostoufi-Moab, Sogol, et al. "Changes in Pediatric DXA Measures of Musculoskeletal Outcomes and Correlation With Quantitative CT Following Treatment of Acute Lymphoblastic Leukemia." Bone, vol. 112, 2018, pp. 128-135.
Mostoufi-Moab S, Kelly A, Mitchell JA, et al. Changes in pediatric DXA measures of musculoskeletal outcomes and correlation with quantitative CT following treatment of acute lymphoblastic leukemia. Bone. 2018;112:128-135.
Mostoufi-Moab, S., Kelly, A., Mitchell, J. A., Baker, J., Zemel, B. S., Brodsky, J., Long, J., & Leonard, M. B. (2018). Changes in pediatric DXA measures of musculoskeletal outcomes and correlation with quantitative CT following treatment of acute lymphoblastic leukemia. Bone, 112, 128-135. https://doi.org/10.1016/j.bone.2018.04.012
Mostoufi-Moab S, et al. Changes in Pediatric DXA Measures of Musculoskeletal Outcomes and Correlation With Quantitative CT Following Treatment of Acute Lymphoblastic Leukemia. Bone. 2018;112:128-135. PubMed PMID: 29679731.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in pediatric DXA measures of musculoskeletal outcomes and correlation with quantitative CT following treatment of acute lymphoblastic leukemia. AU - Mostoufi-Moab,Sogol, AU - Kelly,Andrea, AU - Mitchell,Jonathan A, AU - Baker,Joshua, AU - Zemel,Babette S, AU - Brodsky,Jill, AU - Long,Jin, AU - Leonard,Mary B, Y1 - 2018/04/19/ PY - 2017/11/20/received PY - 2018/03/27/revised PY - 2018/04/14/accepted PY - 2018/4/22/pubmed PY - 2019/4/9/medline PY - 2018/4/22/entrez KW - Acute lymphoblastic leukemia KW - And cortical dimensions KW - Bone mineral content KW - Bone mineral density KW - Dual-energy X-ray absorptiometry SP - 128 EP - 135 JF - Bone JO - Bone VL - 112 N2 - We previously reported significant gains in pQCT measures of tibia trabecular bone mineral density (BMD) and cortical structure following completion of therapy in children and adolescents with acute lymphoblastic leukemia (ALL). The objective of this study was to examine changes in DXA measures used in clinical practice and expressed as Z-scores using robust national reference data. Children and adolescents, ages 5 to 18 years were enrolled within 2 (median 0.8) years of completing ALL therapy. DXA total-body less-head bone mineral content (TBLH-BMC), and spine, total hip, femoral neck, and 1/3rd radius areal BMD (aBMD) were assessed in 45 participants at enrollment and 12-months later. Linear regression models examined correlates of changes in DXA Z-scores. Changes in DXA outcomes were compared to changes in tibia pQCT trabecular and cortical volumetric BMD (vBMD) and cortical area. At enrollment, DXA TBLH-BMC, spine and radius aBMD Z-scores were not significantly reduced in ALL survivors; however, total hip [median -0.74 (IQ range -1.51 to -0.04)] and femoral neck [-0.51 (-1.24 to 0.14)] aBMD Z-scores were lower (both p < 0.01) compared to reference data. DXA Z-scores at all skeletal sites increased over 12 months. Despite improvement, total hip Z-score remained lower at -0.55 (-1.05 to 0.18). The increases in TBLH-BMC, total hip and femoral neck aBMD Z-scores were more pronounced in those enrolled within 6 months of completing ALL therapy, compared to those enrolled at >6 months. Gains in TBLH-BMC, total hip, femoral neck and radius aBMD Z-scores were significantly associated with gains in tibia cortical area Z-scores (R = 0.56 to 0.67, p ≤ 0.001). Changes in TBLH and proximal femur sites were associated with gains in trabecular vBMD Z-scores (R = 0.37 to 0.40; p ≤ 0.01); these associations were not significant when adjusted for gains in cortical area. In summary, gains in DXA measures were most pronounced in total hip and femoral neck following ALL therapy. The gains in all DXA measures, with the exception of lumbar spine, reflected gains in cortical area. Overall, ALL survivors demonstrate skeletal recovery following completion of therapy; a small sub-group continue to demonstrate deficits and benefit from continued observation to ensure improvement over time. SN - 1873-2763 UR - https://www.unboundmedicine.com/medline/citation/29679731/Changes_in_pediatric_DXA_measures_of_musculoskeletal_outcomes_and_correlation_with_quantitative_CT_following_treatment_of_acute_lymphoblastic_leukemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S8756-3282(18)30158-3 DB - PRIME DP - Unbound Medicine ER -