Long-term bone health in childhood cancer survivors: underappreciated and undertreated?
Menée aux Pays-Bas à partir de données portant sur 2 003 adultes ayant survécu à un cancer pédiatrique (âge moyen lors de l'étude : 33,1 ans), cette étude de cohorte analyse les facteurs associés au risque de densité minérale osseuse faible et très faible ainsi qu'au risque de fracture
Maintenance of bone quality is an ongoing challenge throughout the lifespan of a cancer survivor. Although bone metastases are the most obvious scenario in which a malignancy negatively affects bone, non-metastatic cancer can also impair bone metabolism by direct (eg, cancer mediated) or indirect (eg, treatment or consequences of such) mechanisms. 1 Updated American Society of Clinical Oncology (ASCO) clinical practice guidelines were published in 2019 to provide guidance on how to monitor and treat adult patients with cancer and concurrent osteoporosis. 2 However, the general risk of developing osteoporosis and consequent fragility fractures in the increasingly large group of childhood cancer survivors remains underappreciated. Long-term clinical data on bone health in this population and recommendations on monitoring and treatment are missing. In The Lancet Diabetology & Endocrinology, Jenneke E van Atteveld and colleagues 3 report their cross-sectional study of the DCSS-LATER cohort of childhood cancer survivors (ie, alive for at least 5 years after diagnosis of childhood cancer; mean age at participation was 33·1 years [SD 7·2], and 966 [48·2%] of 2003 participants enrolled were female and 1037 [51·8%] were male [data on ethnicity and race were not available due to national policies]). In their study, van Atteveld and colleagues highlight that childhood cancer is not only associated with an increased risk of low bone mineral density (BMD), but also with a 3–5-times increased risk of developing fractures in adulthood. Additionally, they succeeded in identifying a number of risk factors associated with low BMD and fractures
The Lancet Diabetes & Endocrinology , commentaire, 2021