In a real-world analysis, researchers found high rates of osteoporosis or osteopenia and vertebral fractures in patients with lymphoma treated using chemotherapy with or without other treatments. The research team reported their results in the journal BMC Musculoskeletal Disorders.

Researchers based in Italy performed this cross-sectional, observational study that included patients who received antineoplastic therapy after a lymphoma diagnosis. Patients were required to have had a complete response to therapy for at least 1 year to be included in this analysis. The researchers evaluated results of laboratory and imaging tests, in addition to tools for assessing functional status and quality of life. These included the SARC-F sarcopenia screening tool and the mini-Osteoporosis Quality of Life (mini-OQoL) questionnaire.

The study population included 29 patients, and the mean patient age was 61.4 years. Most patients (86.2%) had non-Hodgkin lymphoma. All patients (100.0%) had been treated with chemotherapy, while 58.6% also received corticosteroid therapy, and 13.8% received radiation therapy.

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All but 2 patients received dual-energy x-ray absorptiometry (DEXA) scanning of the femur, and all but 1 had vertebral lumbar DEXA scanning. Femoral DEXA scanning showed osteopenia in 37.0% of evaluated patients and osteoporosis in 7.4%. Vertebral lumbar DEXA scanning showed osteopenia in 25.0% of evaluated patients and osteoporosis in 25.0%. Additionally, most patients (65.5%) in this study showed evidence of vertebral fractures. This included 34.5% of patients showing evidence of 1 or 2 fractures, and 31.0% showing 3 or more fractures.

Vitamin D insufficiency was seen in 75.9% of patients, and another 6.9% showed the same deficiency. Elevated parathyroid hormone (PTH) levels were also seen in some patients, with 20.7% of patients showing levels above normal for PTH. Elevated PTH was significantly associated with prior lymphoma therapy involving multiple forms of chemotherapy and high-dose corticosteroids (P =.02). More advanced age was also associated with elevated PTH (P =.02).

Scores on the SARC-F reflected sarcopenia in 62% of patients. Results on the mini-OQoL questionnaire demonstrated a mild status in 37.9% of patients, a moderate status in 55.2% of patients, and a severe status in 6.9% of patients.

“According to the results of our study, performing screening tests for osteoporosis in patients suffering from lymphomas should be recommended and should be included in clinical practice among the routine tests to be performed,” the researchers wrote in their report. They concluded that an approach that may enable recognition of adverse events in long-term survivors could involve personalized lymphoma therapy and a follow-up plan that includes bone health surveillance.


Mancuso S, Scaturro D, Santoro M, et al. Bone damage after chemotherapy for lymphoma: a real-world experience. BMC Musculoskelet Disord. 2021;22(1):1024. doi:10.1186/s12891-021-04904-3