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Article
High incidence of vertebral fractures in children with acute lymphoblastic leukemia 12 months after the initiation of therapy
Journal of Clinical Oncology
  • 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 University
  • 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 University
  • 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
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.

Citation Information
Nathalie Alos, Ronald M. Grant, Timothy Ramsay, Jacqueline Halton, et al.. "High incidence of vertebral fractures in children with acute lymphoblastic leukemia 12 months after the initiation of therapy" Journal of Clinical Oncology Vol. 30 Iss. 22 (2012) p. 2760 - 2767
Available at: http://works.bepress.com/robert-stein/8/