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Severity of reduced bone mineral density and risk of fractures in long-term survivors of childhood leukemia and lymphoma undergoing guideline-recommended surveillance for bone health.

接受指南推荐的骨健康监测的儿童白血病和淋巴瘤长期幸存者骨密度降低的严重程度和骨折风险。

  • 影响因子:4.78
  • DOI:10.1002/cncr.32512
  • 作者列表:"Bloomhardt HM","Sint K","Ross WL","Rotatori J","Ness K","Robinson C","Carpenter TO","Chow EJ","Kadan-Lottick NS
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Survivors of childhood leukemia/lymphoma are at increased risk for reduced bone mineral density (BMD). The authors sought to determine the frequency of reduced BMD detected by off-therapy surveillance, factors associated with reduced BMD, and the association of reduced BMD with fractures. METHODS:This cross-sectional study included childhood leukemia/lymphoma survivors attending 2 survivorship clinics who received guideline-recommended BMD surveillance ≥2 years post-therapy with dual-energy x-ray absorptiometry (from January 1, 2004 to August 31, 2016). Lumbar spine BMD z-scores were height-for-age-adjusted. Low and very low BMD were >1 SD and >2 SDs below norms, respectively. Treatment, chronic conditions, and fractures were abstracted from medical records. Logistic regression was used to examine the association of low BMD with patient/treatment factors and fractures. RESULTS:In total, 542 patients (51.5% female) with a mean age of 15.5 years (range, 4.4-52.2 years) who were 6 years post-therapy (range, 2.0-35.1 years) were evaluated, including 116 who reported post-therapy fractures. Lumbar spine low BMD was identified in 17.2% of survivors, and very low BMD was identified in 3.5% of survivors, but frequencies varied considerably between subgroups; 10.8% of survivors aged 15 to 19 years at diagnosis had very low BMD. In multivariable analyses, older age at diagnosis, white race, and being underweight were significantly associated with low BMD. Survivors with low BMD had greater odds of nondigit fractures (odds ratio, 2.2; 95% CI, 1.3-3.7) and specifically long-bone fractures (odds ratio, 2.7; 95% CI, 1.5-4.7). CONCLUSIONS:In this study of childhood leukemia/lymphoma survivors undergoing guideline-recommended dual-energy x-ray absorptiometry surveillance, patients who were older at diagnosis, white, and underweight were at the highest risk for lumbar spine low BMD. Low BMD was associated with a greater risk of fractures, emphasizing the clinical importance of surveillance.

摘要

背景: 儿童白血病/淋巴瘤幸存者的骨密度 (BMD) 降低的风险增加。作者试图确定非治疗监测发现的BMD降低的频率、与BMD降低相关的因素以及BMD降低与骨折的相关性。 方法: 这项横断面研究包括在 2 个生存诊所就诊的儿童白血病/淋巴瘤幸存者,他们接受了指南推荐的双能x线骨密度仪治疗后 ≥ 2 年的BMD监测 (从 1 月 1 日起,2 004 至 8 月 3 1 日,2 0 1 6)。腰椎BMD z评分经身高年龄校正。低和极低BMD分别> 1 SD和> 2 SDs低于标准。从病历中提取治疗、慢性疾病和骨折。采用Logistic回归分析低BMD与患者/治疗因素和骨折的相关性。 结果: 总共有 542 例患者 (51.5% 为女性),平均年龄 15.5 岁 (范围,4.4-52.2 岁),治疗后 6 年 (范围,2.0-35.1 年) 进行了评估,包括 116 谁报告治疗后骨折。17.2% 的幸存者发现腰椎低BMD,3.5% 的幸存者发现极低BMD,但各亚组之间的频率差异很大; 10.8% 诊断时 15 ~ 19 岁的幸存者BMD非常低。在多变量分析中,诊断时年龄较大、白种人、体重过轻与低BMD显著相关。低BMD的幸存者发生非数字骨折的几率更大 (比值比,2.2; 95% CI,1.3-3.7),特别是长骨骨折 (比值比,2.7; 95% CI,1.5-4.7)。 结论: 在这项接受指南推荐的双能x线吸收测量法监测的儿童白血病/淋巴瘤幸存者的研究中,诊断时年龄较大的患者,体重不足是腰椎低BMD的最高风险。低BMD与更大的骨折风险相关,强调监测的临床重要性。

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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