Background. Osteoporosis and pathological fractures have been observed in children with a malignancy. The mechanisms of osteopenia in childhood malignancies have not been well established. The purpose of the present study was to evaluate changes in bone turnover and in bone hormonal metabolism in children with a malignancy at completion of their chemotherapy. Procedure. Serum levels of human intact osteocalcin, type I collagen carboxyterminal propeptide (PICP), type I collagen carboxyterminal telopeptide (ICTP), 25-hydroxyvitamin D [25-(OH)-D], 1,25-dihydroxyvitamin D [1,25-(OH) 2 -D], intact parathyroid hormone, insulin-like growth factor I (IGF-I), IGF binding protein 3 (IGFBP-3), alkaline phosphatase, calcium, and phosphate were analyzed in 22 children with acute lymphoblastic leukemia and in 26 children with other malignancies. Results were expressed as Z-scores [mean (95% confidence intervals)] relative to healthy Caucasian-children. Results. The marker of collagen degradation (ICTP) was significantly increased [1.43 (1.10-1.76), P < 0.0001] compared to reference values, whereas the markers of bone formation (PICP, osteocalcin) were not changed [0.07 (-0.55 to 0.49), 0.35 (-0.05 to 0.74), respectively, NS]. Serum 25-(OH)-D, 1,25-(OH) 2 -D, and calcium were significantly reduced [-0.65 (-0.87 to -0.42), -0.68 (-0.92 to -0.42), -1.42 (-1.80 to -1.04), P < 0.0001, respectively]. Conclusions. Disturbance in bone turnover with low serum 25-(OH)-D, 1,25-(OH) 2 -D, and calcium was observed in children with a malignancy at completion of their chemotherapy.
A controlled study determining the possible benefits of vitamin D and calcium supplementation on bone turnover could be considered in these patients. Med. Pediatr. Oncol. 33:455-461, 1999.