Bone Health Management Key in Childhood Cancer Survivors

As part of a literature review, published in the June issue of the Annals of Oncology, recommendations are presented for the management of bone health in survivors of childhood cancer.

Gemma Marcucci, M.D., from the University of Florence in Italy, and colleagues, as part of the International Osteoporosis Foundation Cancer and Bone Working Group, reviewed the literature and developed recommendations for the management of bone health in childhood cancer survivors.

The authors note that childhood cancer treatment can impair the attainment of peak bone mass and predispose children to premature onset of low bone mineral density or other bone-related side effects, such as impairment of bone quality or avascular necrosis of bone. Persistence of lower bone mineral density and microarchitectural deterioration during adulthood can increase fracture risk. To define specific groups at higher risk for long-term bone complications, identify unrecognized long-term adverse effects, and improve patient care, long-term follow-up of childhood cancer survivors is essential. Children and adolescents with cancer history should be carefully monitored; patients should be informed of potential late complications from their previous treatment. Recommendations for management of bone health include assessment and monitoring of bone mineral density and bone turnover markers, while prevention and treatment include calcium and vitamin D supplementation, physical activity, correction of endocrine alterations, and treatments to decrease bone fragility.

"Particular attention during cancer treatment should be paid to reduce the impact on future adult bone health," the authors write. "Once in remission or cured, patients should undergo prolonged follow-up for bone fragility."

Several authors disclosed financial ties to the pharmaceutical industry.

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