Bone Loss and Osteoporosis in Childhood Cancer Survivors

Certain treatments for childhood cancer may cause a loss of bone strength.

This loss is especially concerning because bones normally grow and become heavier during childhood and adolescence.

Loss of bone strength may result in a condition called osteoporosis later in life.

Childhood cancer survivors can take steps to help prevent bone strength loss.

Cancer treatments that can cause bone loss

• Corticosteroids (such as prednisone and dexamethasone)
• Methotrexate
• Radiation to weight-bearing bones (legs, hips, spine)

Conditions that may lead to bone loss

• Low levels of female or male hormones
• Growth hormone deficiency
• High levels of thyroid hormone
• Chronic graft-versus-host disease requiring prolonged therapy with corticosteroids
• Prolonged periods of inactivity (bed rest)

Other medical treatments that can cause bone loss

• Certain anticonvulsant medicines (such as phenytoin sodium and barbiturates)
• Antacids with aluminum (such as Maalox® or Amphogel®)
• Medications for treatment of early puberty and endometriosis (such as Lupron Depot®)
• High doses of heparin (used to prevent blood clots), especially with prolonged use
• Cholestyramine (used to reduce blood cholesterol)

Other risk factors

Bone problems that may occur after cancer treatment

What survivors can do for bone health

Know your risks and monitor your health

Childhood cancer survivors should have annual checkups.

Share a copy of your Survivorship Care Plan with your physician. The plan includes details about your cancer treatment and information about health problems that may occur because of your treatment.

Recommended screenings for bone density

If you are at risk, your provider will likely recommend a baseline bone density scan when you begin long-term follow-up care.

The most commonly used bone density test is the dual X-ray absorptiometry, which is also called DXA. This test uses special X-ray techniques to measure bone thickness and the patient’s risk of breaking a bone.

Based on the results, the doctor can advise about ways to improve bone strength and when to have follow-up studies.

Prevention

People can take action to lower the risk of osteoporosis.

• Participate in regular weight-bearing and resistance exercise. This type of activity puts pressure on the bones and builds bone density. Examples include:
  • Light weightlifting
  • Walking
  • Hiking
  • Jogging
  • Climbing stairs
  • Tennis
  • Dancing
  • Jumping rope
• Don’t smoke.
• Don’t drink alcohol in excess.
• Eat a diet high in calcium and get enough Vitamin D. For more information, read Calcium and Vitamin D: Important at Every Age from the National Institutes of Health.

For more information, visit the Children’s Oncology Group’s Keeping Your Bones Healthy Health Link.