在白血病治疗后出现普遍骨坏死病变的儿童早期，骨密度明显降低

IF 5.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Journal of Bone and Mineral Research Pub Date : 2023-06-16 DOI:10.1002/jbmr.4870

Jacqueline M. Halton, Jinui Ma, Paul Babyn, Mary Ann Matzinger, Sue C. Kaste, Maya Scharke, Conrad V. Fernandez, Paivi Miettunen, Josephine Ho, Nathalie Alos, Sharon Abish, Ronald Barr, Elizabeth Cairney, David B. Dix, Ronald M. Grant, Sara Israels, Victor Lewis, Beverly Wilson, Stephanie Atkinson, David Cabral, Elizabeth Cummings, Celia Rodd, Robert Stein, Anne Marie Sbrocchi, Jacob L. Jaremko, Khaldoun Koujok, Nazih Shenouda, Frank Rauch, Kerry Siminoski, Leanne M. Ward, the Canadian STOPP Consortium

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引用次数: 0

摘要

骨坏死(ON)是儿童急性淋巴细胞白血病的严重并发症。我们通过白血病治疗后1年多的一次性多位点磁共振成像(MRI)来确定患者群体中骨质坏死病变的患病率。评估MRI结果与临床因素的关系(包括骨矿物质密度的纵向变化[BMD])。86名儿童参加了儿童人群类固醇相关骨质疏松症(STOPP)研究，在治疗后3.1±1.3年评估ON。30名儿童共确诊ON病灶150个(35%)。腰椎(LS) BMD z -评分(mean±SD)在诊断时较低，在患有和未患有ON的患者之间相似(- 1.09±1.53对- 1.27±1.25,p = 0.549)。患有ON的儿童的LS BMD z -评分从基线到12个月下降(- 0.31±1.02)，而没有ON的儿童则没有下降(0.13±0.82,p = 0.035);从基线到24个月，两组的髋关节BMD z -评分均有所下降，但与无ON组相比，ON组的下降幅度更大(- 1.77±1.22)(- 1.03±1.07,p = 0.045)。MRI检查时，ON患儿的平均全髋和全身(TB) BMD z -评分较低(髋关节- 0.98±0.95比- 0.28±1.06,p = 0.010;TB - 1.36±1.10 vs - 0.48±1.50,p = 0.018)。有ON的11/30(37%)发生疼痛，无ON的20/56(36%)发生疼痛，p = 0.841。在多变量模型中，诊断时年龄较大(比值比[OR] 1.57;95%置信区间[CI]， 1.15-2.13;p = 0.004)， MRI髋部BMD z评分(OR 2.23;95% ci, 1.02-4.87;p = 0.046)与ON独立相关。总体而言，三分之一的儿童在白血病治疗后表现为ON。在治疗的前1年和2年，ON患者的脊柱和髋关节BMD z -评分分别有更大的下降。老年和较低的髋关节BMD z -评分在MRI上与普遍的非治疗期ON显著相关。这些数据有助于确定有ON风险的儿童。©2023作者。由Wiley期刊有限责任公司代表美国骨与矿物研究协会(ASBMR)出版的骨与矿物研究杂志。

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Reductions in Bone Mineral Density Are Apparent Early in Children With Prevalent Osteonecrosis Lesions Following Leukemia Therapy

Osteonecrosis (ON) is a serious complication of childhood acute lymphoblastic leukemia. We determined the prevalence of osteonecrotic lesions in our patient population by a one-time multisite magnetic resonance imaging (MRI) more than 1 year following leukemia therapy. MRI findings were evaluated in relationship to clinical factors (including longitudinal changes in bone mineral density [BMD]). Eighty-six children enrolled in the Steroid Associated Osteoporosis in the Pediatric Population (STOPP) study were evaluated for ON at 3.1 ± 1.3 years following therapy. Thirty children had a total of 150 confirmed ON lesions (35%). Lumbar spine (LS) BMD Z-scores (mean ± SD) were low at diagnosis and similar between patients with and without ON (−1.09 ± 1.53 versus −1.27 ± 1.25, p = 0.549). LS BMD Z-scores declined from baseline to 12 months in children with ON (−0.31 ± 1.02) but not in those without (0.13 ± 0.82, p = 0.035); the hip BMD Z-scores from baseline to 24 months declined in both groups, but to a greater extent in those with ON (−1.77 ± 1.22) compared to those without (−1.03 ± 1.07, p = 0.045). At the time of the MRI, mean total hip and total body (TB) BMD Z-scores were lower in children with ON (hip −0.98 ± 0.95 versus −0.28 ± 1.06, p = 0.010; TB −1.36 ± 1.10 versus −0.48 ± 1.50, p = 0.018). Pain occurred in 11/30 (37%) with ON versus 20/56 (36%) without, p = 0.841. In multivariable models, older age at diagnosis (odds ratio [OR] 1.57; 95% confidence interval [CI], 1.15–2.13; p = 0.004), and hip BMD Z-score at MRI (OR 2.23; 95% CI, 1.02–4.87; p = 0.046) were independently associated with ON. Overall, one-third of children demonstrated ON after leukemia therapy. Those with ON had greater reductions in spine and hip BMD Z-scores in the first 1 and 2 years of therapy, respectively. Older age and lower hip BMD Z-scores at MRI were significantly associated with prevalent, off-therapy ON. These data assist in identifying children at risk of ON. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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来源期刊

Journal of Bone and Mineral Research 医学-内分泌学与代谢

CiteScore

11.30

自引率

6.50%

发文量

257

审稿时长

2 months

期刊介绍： The Journal of Bone and Mineral Research (JBMR) publishes highly impactful original manuscripts, reviews, and special articles on basic, translational and clinical investigations relevant to the musculoskeletal system and mineral metabolism. Specifically, the journal is interested in original research on the biology and physiology of skeletal tissues, interdisciplinary research spanning the musculoskeletal and other systems, including but not limited to immunology, hematology, energy metabolism, cancer biology, and neurology, and systems biology topics using large scale “-omics” approaches. The journal welcomes clinical research on the pathophysiology, treatment and prevention of osteoporosis and fractures, as well as sarcopenia, disorders of bone and mineral metabolism, and rare or genetically determined bone diseases.