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Bone problems in childhood cancer patients

Susan R Rose, MD
Section Editors
David G Poplack, MD
Mitchell E Geffner, MD
Deputy Editor
Alison G Hoppin, MD


Children and adolescents may experience bone problems and endocrine problems during and after therapy for oncologic problems. The bone problems, which may be acute or chronic, and symptomatic or asymptomatic, will be discussed in this topic review.

The related endocrine problems will be discussed briefly here, and in detail separately. (See "Endocrinopathies in the childhood cancer survivor".)


Normal bone formation — Bone forms by deposition of osteoid through osteoblast activity. Resorption of osteoid occurs through osteoclast activity. Resorption actively occurs even in growing children. This allows bone remodeling as bones increase in circumference and length. Length is added to bones in the epiphyseal plate, a metabolically active zone in which chondrocytes and cartilage are converted to osteocytes and calcified matrix. The relatively faster rate of bone formation compared with rate of bone resorption leads to growth in bone size and increase in bone mineral density (BMD). Bone strength and fracture risk are related to bone size, BMD, and microstructural architecture. (See "Normal skeletal development and regulation of bone formation and resorption".)

Both bone size and BMD increase gradually through the childhood years with more rapid increases during puberty [1]. Calcium is added to bone most rapidly between ages 9 and 15 years in girls, and between ages 10 and 18 years in boys [2]. After adult height is achieved, bone size remains stable, but BMD continues to increase until age reaches the mid-to-late 20s (peak bone mass). Subsequently, bone mass and BMD decline very gradually throughout the rest of adult life. If peak bone mass is lower, osteoporosis and fractures may occur earlier in adult life. Bone growth and remodeling are regulated by endogenous hormones, including growth hormone, sex steroids, growth factors, and cytokines, as well as exogenous factors such as nutrition including vitamin D, and weight-bearing exercise [3].

Effects of cancer — Childhood cancer can affect bone metabolism and growth through a variety of mechanisms. The relative contributions of these factors to bone disease in a particular patient, and the contribution of genetics, are often unclear [4].


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Literature review current through: Mar 2017. | This topic last updated: Apr 10, 2017.
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