Bone Health in Childhood Cancer Survivors
Summary
Bone health in childhood cancer survivors is frequently compromised by the cytotoxic and hormonal effects of chemotherapy, radiotherapy and haematopoietic stem cell transplantation during critical periods of skeletal growth. Survivors commonly exhibit reduced bone mineral density (BMD), delayed or impaired bone accrual, increased skeletal fragility and elevated risk of osteopenia and osteoporosis. Contributing mechanisms include direct damage to osteoblast progenitors, enhanced osteoclast activity, disrupted endocrine function (for example growth hormone deficiency), pro-inflammatory cytokine upregulation, marrow adiposity and deficiencies in nutrition or physical activity. Early recognition through regular assessment of bone status and preventive strategies—such as tailored exercise programmes, optimisation of calcium and vitamin D intake and pharmacological modulation of bone remodelling—are vital to preserve long-term skeletal integrity and reduce fracture risk.
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Bone Health in Childhood Cancer Survivors publication trend
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Technical terms
Bone mineral density (BMD): A quantitative measure of mineral content within bone, indicative of its strength and resistance to fracture.
RANK ligand (RANKL): A cytokine essential for osteoclast differentiation and activation, promoting bone resorption.
Osteoprotegerin (OPG): A decoy receptor that binds RANKL, inhibiting its interaction with osteoclast precursors and thus reducing bone resorption.
Bone turnover markers (BTMs): Biochemical substances released during bone formation or resorption, used to monitor remodelling dynamics.
Dual-energy X-ray absorptiometry (DXA): A non-invasive imaging technique for assessing BMD at central and peripheral skeletal sites.
References
- Changes in RANKL, OPG, and 25(OH)D Levels in Children with Leukemia from Diagnosis to Remission. Cancers (2024).
- Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives. Cancers (2022).
- Modifiable risk factors associated with bone deficits in childhood cancer survivors. BMC Pediatrics (2012).
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