Bone mineral density and nutrition in long-term survivors of childhood brain tumors

Janne Anita Kvammen; Einar Stensvold; Kristin Godang; Jens Bollerslev; Tor Åge Myklebust; Petter Brandal; Christine Henriksen; Anne Grete Bechensteen

doi:10.1016/j.clnesp.2022.05.025

Bone mineral density and nutrition in long-term survivors of childhood brain tumors

Clin Nutr ESPEN. 2022 Aug:50:162-169. doi: 10.1016/j.clnesp.2022.05.025. Epub 2022 Jun 4.

Authors

Janne Anita Kvammen¹, Einar Stensvold², Kristin Godang³, Jens Bollerslev⁴, Tor Åge Myklebust⁵, Petter Brandal⁶, Christine Henriksen⁷, Anne Grete Bechensteen⁸

Affiliations

¹ Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway. Electronic address: j.a.kvammen@medisin.uio.no.
² Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Department of Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway.
⁴ Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway; Department of Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Registration, Cancer Registry of Norway, Oslo, Norway; Department of Research and Innovation, More og Romsdal Hospital Trust, Ålesund, Norway.
⁶ Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway.
⁷ Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁸ Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway.

PMID: 35871919
DOI: 10.1016/j.clnesp.2022.05.025

Abstract

Background and aims: Childhood cancer survivors are at risk of unwanted late effects. The primary aim of this study was to assess bone mineral density Z-scores (BMDz) in long-term survivors of childhood medulloblastoma (MB) or central nervous system supratentorial primitive neuroectodermal tumor (CNS-PNET). Secondary aims were to describe nutrient intake, vitamin D status, physical activity and explore potential risk factors for decreased BMDz.

Methods: All MB and CNS-PNET survivors treated at Oslo University Hospital from 1974 to 2013 were invited to participate in a cross-sectional study. Dual-energy x-ray absorptiometry (Lunar Prodigy) assessed BMDz lumbar spine, BMDz total body, and lean body mass. Decreased BMDz was defined as a combination of low BMDz -1 to -1.99 and very low BMDz ≤-2. Lean body mass index (LMI) was calculated by dividing lean body mass by the squared height. Nutrient intake was assessed by a 3-day food record. Serum 25(OH)D was analyzed. Physical activity was reported by a questionnaire. Descriptive statistics and multivariable Cox regression analyses were applied.

Results: Fifty survivors with a median age of 25.5 years (5.5-51.9) and a median follow-up time of 19.5 years (3.2-40.5) were included. Mean BMDz lumbar spine was -0.8 (SD 1.1, 95% CI: -1.1 to -0.4), and BMDz total body was -0.6 (SD 1.1, 95% CI: -0.9 to -0.3). Decreased BMDz was detected in 48% of the lumbar spine and 34% of the total body measurements. In all, 62% had low calcium, and 69% had low vitamin D intake. 26% of participants had serum 25(OH)D < 50 nmol/L, and 62% reported an inactive lifestyle. Male sex, higher age at diagnosis, and lower LMI were potential risk factors for decreased BMDz.

Conclusions: Long-term survivors of childhood MB and CNS-PNET had decreased BMDz, and risk factors were male sex, higher age at diagnosis, and lower LMI. Inadequate calcium and vitamin D intake, an inactive lifestyle, and a high prevalence of 25(OH)D ≤ 50 nmol/L were detected.

Keywords: Bone; Brain tumors; Childhood cancer survivors; Nutrition; Physical activity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bone Density
Brain Neoplasms*
Calcium
Cross-Sectional Studies
Female
Humans
Male
Neuroectodermal Tumors, Primitive*
Nutritional Status
Survivors
Vitamin D

Substances

Vitamin D
Calcium