Musculoskeletal
Bone fracture
Osteoporosis increases the risk of bone fracture:
In adults and children generally
- A reduction of one standard deviation in bone density is associated with at least a doubling of the fracture risk.
- 15 – 40 % of children with ALL have fractures during treatment.
Fractures related to osteoporosis:
- Can occur at presentation, during and after therapy.
- Incidence of fracture is six times higher in children with ALL compared to healthy controls.
- Change in BMD important:
- Children with fractures did not differ in bone density from children without a fracture, but the decrease in lumbar spine BMD was significantly higher than in the non-fracture group (a change in BMD is more important than the absolute value of BMD).
- Other factors than osteopenia may play a role in the high fracture risk in children with cancer.
- Vincristine-induced neuropathy may cause clumsiness and poorer balance during treatment with a higher risk to fall.
- Changes in bone elasticity or microarchitecture, which cannot be assessed by dual energy X-ray absorptiometry may well play a role.
- Reduced BMD is only one of the risk factors for fractures. BMD accounts for 75–85% of the capability of bone to resist strain, consequently 15–25% may be explained by other skeletal or extraskeletal factors. Bone quality, reflected in bone resorption rate, bone architecture and bone matrix components, and the risk of falling or weight may play an additional role.
