Several factors can increase disposition to low bone mineral density (BMD) among survivors of childhood leukemia or lymphoma, according to research published in Cancer.1 Low BMD in the lumbar spine was found in nearly 1 in 5 of the evaluated survivors.

Survivors of pediatric blood cancers experience increased risk for low BMD, which is linked to a higher risk for osteoporosis later in life as well as a much higher risk for fractures. Low BMD among survivors may be linked directly to anticancer therapies, nutritional deficiencies, or endocrinopathies.

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For this study, researchers evaluated data from 542 pediatric blood cancer survivors who underwent guideline-recommended BMD surveillance for at least 2 years between 2004 and 2016. The researchers attempted to determine whether any factors were related to low BMD in this group and whether low BMD corresponded to a higher risk for fractures.

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Among the 542 survivors, 51.5% were female, 82.2% were white, the mean age was 15.5 years, and the mean time from end of therapy to first dual‐energy x‐ray absorptiometry scan was 6 years (range, 2-35.1). Nearly half (250; 46.1%) of survivors were diagnosed at 0 to 4 years old, 106 were diagnosed at 5 to 9 years old, 66 were diagnosed at 10 to 14 years old, and 120 were diagnosed at 15 to 19 years old.

The researchers found low lumbar spine BMD in 17.2% of participants, with very low BMD in 3.5% of survivors. Being older at diagnosis (P <.01), being white (P =.03), and being underweight (P <.01) were each associated with low BMD.

Low BMD was linked to a greatly increased risk for nondigit fracture (odds ratio, 2.2) and long-bone fracture (odds ratio, 2.7).

“Future studies are needed to investigate long‐term fracture risk and interventions to prevent fractures in the growing population of older adult childhood cancer survivors,” the authors wrote.


1.     Bloomhardt HM, Sint K, Ross WL, et al. Severity of reduced bone mineral density and risk of fractures in long‐term survivors of childhood leukemia and lymphoma undergoing guideline‐recommended surveillance for bone health [published online September 19, 2019]. Cancer. doi:10.1002/cncr.32512