RESUMO
PURPOSE: Osteoporosis is currently receiving particular attention as a sequela in survivors of childhood osteosarcoma. The aim of this study was to evaluate bone mineral density (BMD) changes during methotrexate-based chemotherapy in children and adolescents with osteosarcoma. METHODS: Nine patients with osteosarcoma were included in this retrospective study and compared with eight healthy controls. BMD of the lumbar spine and unaffected femur neck of patients was serially measured by dual-energy x-ray absorptiometry (DXA) before and just after chemotherapy and compared with controls. RESULTS: Four patients (44%) showed decreased lumbar spine BMD and seven patients (78%) showed decreased femur neck BMD, while all controls showed increased lumbar and femur BMD (P=0.024 and P=0.023). The femur neck BMD z-scores decreased from -0.49+/-1.14 to -1.63+/-1.50 (P=0.032). At the end of therapy, five patients (56%) showed femur neck BMD z-scores below -2.0. CONCLUSION: The bone metabolism is disturbed during therapy in children with osteosarcoma, resulting in a reduced BMD with respect to healthy controls. Since a reduced BMD predisposes to osteoporosis, specific attention and therapeutic interventions should be considered.
Assuntos
Adolescente , Criança , Humanos , Absorciometria de Fóton , Densidade Óssea , Quimioterapia Adjuvante , Tratamento Farmacológico , Fêmur , Colo do Fêmur , Coreia (Geográfico) , Metabolismo , Osteoporose , Osteossarcoma , Estudos Retrospectivos , Coluna Vertebral , SobreviventesRESUMO
PURPOSE: The aim of this study was to evaluate the efficacy of pamidronate therapy in children and adolescents with secondary osteoporosis. METHODS: Nine patients (7 males, 2 females, 13.2 +/- 2.5 years, 10.1-17.4 years) with secondary osteoporosis who had a history of severe bone pain and/or fracture were enrolled. Intravenous pamidronate 1.5 mg/kg (0.5 mg/kg for 3 consecutive days) was given every 6 to 8 weeks for 0.86 +/- 0.15 years (6 or 8 cycles). Bone mineral density (BMD) in lumbar spine and femoral neck and their Z-scores were measured before treatment, after the fourth and last cycle (sixth or eighth cycle). RESULTS: Underlying diseases were as follows; neurofibromatosis type 1 (n = 2), epilepsy with/without cerebral palsy (N=2), autoimmune disease treated with steroid (n = 2), hematologic malignancy (n = 3). Bone pain was relieved in most of the patients after the first cycle of treatment, and no more fracture occurred thereafter. There was a significant increase in BMD Z-score of the lumbar spine and femoral neck after the last cycle of therapy, compared to baseline values (from -3.91 +/- 1.79 to 1.86 +/- 1.18, in L1-4 and -3.71 +/- 1.83 to -2.53 +/- 1.77 for femoral neck; P = 0.008 and 0.011, respectively). However, there was no significant change in BMD Z-scores between the fourth cycle and the last cycle. Fever developed in 7 out of 9 patients (77.8%), which was relieved by antipyretics. Total serum levels of calcium and phosphorus were significantly decreased (calcium, P = 0.008; phosphorus, P = 0.015) after pamidronate therapy, and three of them experienced symptomatic hypocalcemia during the first cycle. The growth velocity was normal during follow-up periods (mean, 4.47 +/- 1.69 years; range, 1.05 to 6.77 years). CONCLUSION: In conclusion, pamidronate can be administered to the patients with secondary osteoporosis, relieving the symptoms and signs effectively and safely. However, its side effects should be monitored during treatment.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Antipiréticos , Doenças Autoimunes , Densidade Óssea , Cálcio , Paralisia Cerebral , Difosfonatos , Epilepsia , Colo do Fêmur , Febre , Seguimentos , Neoplasias Hematológicas , Hipocalcemia , Neurofibromatose 1 , Osteoporose , Fósforo , Coluna VertebralRESUMO
High-dose methotrexate (MTX) chemotherapy extends the duration of hospitalization and introduces the risks of serious complications related to delayed MTX excretion. The treatment of delayed MTX excretion is largely dependent on invasive measures such as hemodialysis because the clinical data regarding the efficacy or safety of carboxypetidase G2 is limited. We report here on the cases of two pediatric osteosarcoma patients with delayed MTX excretion and who were successfully managed using supportive measures. Potential life-threatening complications were prevented by administering high doses of leucovorin.
Assuntos
Criança , Humanos , Hospitalização , Leucovorina , Metotrexato , Osteossarcoma , Diálise RenalRESUMO
A 23-year-old female was brought to our pediatric clinic complainting arm and back pain. The pain developed suddenly while she was on a roller coaster and she denied any history of injuries. At First, she visited local orthopedics, and a simple X-ray showed fracture in her left forearm. She received a cast therapy, and and after several months, the fracture lesion of forearm was improved. But the pain in her arm and back still remained. Eight years ago, she was diagnosed with rhabdomyosarcoma of the left forearm and received a combination of chemotherapy and radiotherapy. She was slightly built and became increasingly thinner over the course of, chemotherapy. After completing chemotherapy, she was evaluated for bone mineral density (BMD) and was found to be osteoporotic. She was advised to take calcium supplements and exercise regular, and was assesse for BMD annually, using a duel energy X-ray absorpometry (DXA). However, her BMD did not improve and she never achieved an adequate peak bone mass. This case showed that failure to gain adequate peak bone mass during growth did not result in a later increase in bone mass in the young adult period, and finally caused multiple insufficient fractures.
Assuntos
Adolescente , Feminino , Humanos , Adulto Jovem , Braço , Dor nas Costas , Densidade Óssea , Cálcio , Antebraço , Ortopedia , Osteoporose , RabdomiossarcomaRESUMO
PURPOSE: Pseudohypoparathyroidism(PHP) is caused by a defect of G protein and receptor despite of normal parathyroid hormone(PTH) secretion. It is a rare disorder characterized by hypocalcemia, hyperphophatemia, elevated PTH levels and albright hereditory osteodystrophy(AHO). We retrospectively reviewed the clinical characteristics of PHP. METHODS: We reviewed clinical features, laboratory findings, and outcome to treatment of 8 PHP patients, diagnosed at Seoul National University Hospital from 1988 to rool. RESULTS: Male to Female ratio was 1.7:1 and mean age at diagnosis was 11.8 years old. The initial average height SDS was 0.13+/-.08 and the average weight SDS was 0.43+/-.31. The most common symptom was seizure. Only one patient had typical AHO, three patients had mental retardation. Brain MRI or CT showed basal ganglia calcification in 3 patients. All patients treated with vitamin D and calcium supplementation could maintained normal serum levels of calcium and phophorus. CONCLUSION: PHP should be suspected in patient with seizure of unknown origin, aged above 5 year-old. AHO and mental retardation could be adjuvant signs to the diagnosis of PHP. But definite diagnosis could be made by laboratory work up.