Year: 2009
Type: letter
Abstract: We appreciate Drs. Hogler and Shaw reiterating an issue that we clearly discussed in our article1 as a study limitation, ie, that dual-energy X-Ray absorptiometry (DXA) measurements do not take into account volumetric density and may not be reliable in individuals who are very short. In the International Society for Clinical Densitometry 2007 Adult and Pediatric Official Positions published in Bone in December 2008,2 it was recommended that areal bone mineral density (BMD) should be used for correction in pediatric subjects who have not completed puberty or linear growth. However, all the subject in our study were adults, with an average age of 30 years, and only 4 of the 18 subjects with low BMD were below the 2.25 standard deviation (SD) of age-specific, race-specific and sex-specific normative means for height. We, therefore, chose not to statistically adjust their z-scores, given that there is no clearly validated adult standard for doing so. Unfortunately, we do not have data to compare fracture occurrence in our study subjects, and fracture risk is difficult to determine solely from DXA bone mineral density estimates because there are no measures of bone quality beyond bone mass.3 We agree that focused research is needed on risk of fracture in long-term survivors of pediatric cancer. We believe that our study results suggest, but by no means prove, that adult survivors of childhood acute lymphoblastic leukemia, particularly males, are at elevated risk for early onset osteopenia and that prudent medical surveillance is justified.
Source: Cancer
DOI: 10.1002/cncr.24456
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2046464575