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Bone mineral density and its determinants in long-term childhood Hodgkin's lymphoma survivors - a pilot study

Milena Ivanova Belcheva, Ruzha Zlatanova Pancheva, Yana Dimitrova Bocheva, Boyan Dobrev Balev, Valeriya Ignatova Kaleva, Violeta Mihova Iotova


Aim: The purpose of this study is to evaluate bone mineral density (BMD) and its determinants in long-term survivors of childhood Hodgkin`s lymphoma (HL), treated and followed up in a single center.

Methods: We compared 18 long-term survivors between 18 and 34 years of age (mean age 26.2 ± 3.9 yrs), to 25 age- and sex-matched controls and assessed their anthropometric features and biochemical and hormonal parameters. The participants` BMD, BMD Z-scores and young-adult T-scores, bone mineral content (BMC), fat mass (FM), lean mass (LM) and appendicular lean mass (ALM) were measured by whole body Dual-energy X-ray absorptiometry (DEXA). Their physical activity (PA) was assessed through the means of questionnaires and semi-structured interviews.

Results: An average of 12.3 ± 3.2 yrs after treatment completion, HL survivors had lower BMD Z-scores and BMD young-adult T-scores (-0.03 ± 1.07 vs 0.69 ± 1.19, р = 0.04 and -0.20 ± 0.92 vs 0.48 ± 1.27, р = 0.07, respectively). Hypergonadotropic hypogonadism was found in 54.5% of male survivors, and 3 out of 7 female survivors presented with thyroid dysfunction. No participant had SDSBMD lower than -2. The frequency rate of BMD Z-scores < -1 among survivors was 16.7% (3/18). All HL survivors with a BMD Z-score < -1 were males. They were treated with more intensive therapy (n=3) and 2 of them presented with treatment-induced hypogonadism. Compared to controls, survivors, especially women, exhibited lower physical sports activity frequency and duration (1.6 ± 2.1 vs 3.7 ± 3.4/week, p = 0.02 and 90 ± 127 vs 279 ± 419 min/week, p = 0.06). BMD positively correlated with LM, ALM and physical activity parameters. Lean mass, older age at diagnosis and the dose of the radiotherapy delivered during treatment were all independent predictors of BMD in HL survivors.

Conclusion: Compared to controls, long-term childhood HL survivors have lower BMD Z-scores and BMD T-scores at an age close to their individual bone mass peak. Males treated with intensive therapy present with deteriorated bone health in the context of therapy-induced hypogonadism and low physical activity. The timely detection of low BMD, treating hormonal dysfunctions and increasing PA are effective means to preventing and delaying late morbidity.


bone mineral density, Hodgkin's lymphoma, long-term survivors

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van Leeuwen FE, Ng AK. Late sequelae in Hodgkin lymphoma survivors. Hematol Oncol 2017;35(S1):60-66

van Dorp W, van Beek RD, Laven JSE, Pieters R, de Munick Keizer-Schrama SMPF, van den Heuvel-Eibrink MM. Long-term endocrine side effecta of childhood Hodgkin's lymphoma treatment: a review. Human Reprod Update 2012;18(1):12-28

Sala A, Talsma D, Webber C, Pogsate S, Atkinson S, Barr R. Eur J Cancer Care 2007;16:373-379

van Breek RD, van den Heuvel-Eibrink MM, Hakvoort-Cammel FG, van den Bos C, van der Pal HJH, Krenning EP, de Rijke YB, Pietrrs R, de Muinck Keizer-Schrema SMPF. Bone mineral density, growth, and thyroid function in long-term survivors of pediatric Hodgkin's lymphoma treated with chemotherapy only. J Clin Endocrinol Metab 2009;94:1904-1909

Muszynska-Roslan K, Latoch E, Konstantynowicz J, et al. Bone mineral density in pediatric survivors of Hodgkin and non-Hodgkin lymphomas. Advances Med Sci 2014;59:200-205

Godin G, RJ Shephard. Godin leizure-time exercice questionnaire. Med Sci Sports Exerc 1997;26 Suppl 6:S36-38

Global recommendations on physical activity for health. World Health Organization 2010 ISBN 9789241599979

Grabtree NJ, Arabi A, Bachrach LK, Fewtrell M, Fuleihan GEH, Kecskemety HH, Jaworski M, Gordon CM; International Society for Clinical Densitometry Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: The Revised 2013 ISCD Pediatric Official Position. J Clin Densitom 2014;17:225-242

Препоръки за добра практика по остеопороза, БДЕ, София, 2013

Kaste, SC, Metzger ML, Minhas A, et al. Pediatric Hodgkin lymphoma survivors at negligible risk for significant bone mineral density deficits. Pediatr Blood Cancer 2009;52(4):516-521

Whiting SJ, Vatanparast H, Baxter-Jones A, et al. Factors that affect bone mineral accrual in the adolescent growth spurt. J Nutr 2004;134:696S-700S

Clark ST, Radford JA, Crowther D, Swindell R, Shalet SM. Gonadal function following chemotherapy for Hodgkin's disease: a comparative study of ChVPP and seven-drug hybrid regimen. J Clin Oncol 1995;13:134-139

Heikens J, Behrendt H, Adriaanse R, Berghout A. Irreversible gonadal damage in male survivors of pediatric Hodgkin's disease. Cancer 1996;78:2020-2024

Schellong G, Treatment of children and adolescents with Hodgkin's disease: the experience of the German-Austrian Paediatric Study Group. Baillieres Clin Hematol 1996;9:619-634

van Beek RD, Smit M, van den Heuvel-Eibrink MM, et al. Inhibin B is superior to FSH as a serum marker for spermatogenesis in men treated for Hodgkin's lymphoma with chemotherapy during childhood. Hum Reprod 2007;22:3215-3222

Makovey J, Naganathan V, Sambrook P. Gender differences in relationships between body composition components, their distribution and bone mineral density: a cross-sectional opposite sex twin study. Osteoporos INT 2005;16(12):1495-14505

Gomez-Cabello A, Ara I, Gonzalez-Agüero A, et al. Effects of training on bone mass in older adults. Sports Med. 2012;42(4):301-325

Joyce ED, VG Nolan, Ness KK, et al. Association of muscle strenght and bone mineral density in adult survivors of childhood acute lymphoblastic leukemia. Arch Phys Med Rehabil 2011;92(6):873-879



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