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High BMI Tied To Osteonecrosis In Childhood Leukemia ...
A high body mass index (BMI) increases the risk for osteonecrosis in children with acute lymphoblastic leukemia (ALL), according to Finnish researchers
In the April 20th issue of the Journal of Clinical Oncology, Dr. Riitta A. Niinimaki of Oulu University and colleagues note that this is the first time such an observation has been made.
The researchers prospectively studied 97 patients who had magnetic resonance imaging (MRI) of the lower extremities following treatment using the Nordic ALL protocols.
Overall, 23 patients (24%) showed evidence of osteonecrosis. Of these, 47.8% were obese, compared to 18.9% of children without the condition. Independent risk factors for osteonecrosis were a high BMI, being female, greater age at diagnosis (9.4 versus 5.4 years), and a higher cumulative dexamethasone dose.
Prednisone dosage did not have a significant influence. However, the incidence of osteonecrosis decreased significantly from 36% to 7% when, in line with revised Nordic protocols, dexamethasone exposure was reduced.
This was achieved by shortening such exposure from 3 to 4 weeks during the delayed-intensification phase of therapy, to 2 weeks with tapering.
"The role of obesity in the development of osteonecrosis," the
researchers conclude, "and the possible benefit of interventions against
obesity for the prevention or treatment of osteonecrosis require further
studies."
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