Objective: Acute leukemia is the most common malignancy in children and has been reported to be associated with low bone mass. The urinary cross-links lysyl-pyridinoline (dipyridinoline [Dpd]) are established biochemical markers of osteoclastic bone resorption and collagen degradation. We believe that acute leukemia treatment; we wanted to investigate the effect on bone mineral density (BMD, g/cm2) and bone resorption. It has been asked to investigate whether this effect is continuing or not with the passing years.
Methodology: Our materials were 29 leukemia patients who completed their treatments. The patients were divided into two groups. Group I consisted of 19 patients (the ones in the 1.00±0.15th months after treatment) and Group II consisted of 10 patients (the ones in the 43.36±18.39th month). 52 healthy children formed BMD group and 20 children formed Dpd control group. The BMD and urine Dpd values of the healthy ones and the patients were measured.
Results: In 10 of total 29 cases (4.48) osteopeni and osteoporosis were determined. A meaningful difference could not be found in the average values of BMD between the groups. In the evaluation of all cases and the groups separately, any effect of the chemotheraphy could not be found on BMD. It was found that age had a meaningful effect on BMD in the Group I (p<0.05). The age and the time after the treatment affected BMD in a meaningful level in Group II (p<0.00001, p<0.05, respectively). BMD was increasing significantly with age and interval. The average BMD of 29 cases was 0.66±0.17g/cm2, while of control group was 0.65±0.16g/cm2. Average Dpd levels in urine were 32.92+13.74 and 30.15±13.48nmol/mmol Cr in the patients and control group respectively. The average BMD and Dpd values of the patients were not different than of the control group. A meaningful negative relation was determined between BMD and Dpd values separately in both all cases and Group II. Dpd value in urine decreased with the increase in the value of BMD. As the age of diagnosis increased, BMD increased. When the age of diagnosis increased, Dpd was determined as decreased. In the evaluation of all cases and groups separately, bone resorption and BMD were not different between the one taking radiotherapy (0.60±0.15g/cm2 and 31.29±18.09nmol/mmol Cr) and the one not taking radiotherapy (0.67±0.20g/cm2 and 37.29±11.91nmol/mmol Cr). In Group I, there was a meaningful difference (p<0.05) between Bsds of the patients taking cranial radiotherapy (1.04±0.74) and the ones not taking cranial radiotherapy (−0.19±0.80) and taking extracranial radiotherapy (−1.36±0.93). Cranial radiotherapy effected Bsds negatively in Group I while this effect could not be seen in Group II.
Conclusion: It was concluded that the childrens completing acute leukemia treatment could reach carry out the ideal height and weight with a sufficient and balanced nutrition program and maintain BMD values proper to their ages.
