Childhood cancer survivors with premature ovarian insufficiency have low bone mineral density at long term follow-up.
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BACKGROUND: Childhood cancer survivors (CCS) are reported to have decreased bone mineral density (BMD). PURPOSE: Is premature ovarian insufficiency (POI) an important risk factor for low BMD in CCS at long term follow-up? PATIENTS AND METHODS: Altogether 167 female CCS, median age 34 (19-57) years, treated for childhood cancer under age 18 years between 1964 and 2008, with a follow-up time of 25 (12-41) years, and 164 matched controls took part in this cross-sectional study, including blood samples, anthropometric measurements, dual-energy X-ray absorptiometry (DXA), and questionnaires. RESULTS: CCS with primary POI (n = 22) had lower BMD in lumbar spine L1-L4 1.13 (0.79-1.39) g/cm2 compared with controls 1.20 (0.84-1.56) g/cm2 (p = 0.005) and lower BMD in femoral neck 0.89 (0.72-1.16) g/cm2 compared with controls 1.00 (0.69-1.48) g/cm2 (p = 0.020). CCS with primary POI had significantly reduced levels of androgens and low BMI < 20 kg/m2 (p = 0.003). Odds Ratio for a low BMD < - 1 SD in L1-L4 was increased among CCS with primary POI (2.76 (1.01-7.52)), but also after abdominal irradiation (3.42 (1.52-7.70)) and all irradiation (1.98 (1.05-3.76)). CONCLUSIONS: Female childhood cancer survivors are at risk of low BMD and POI is an additional risk factor at long term follow-up. Besides hypogonadism and insufficient Hormone Replacement Therapy (HRT), abdominal radiotherapy, low levels of androgens and low BMI may confer to the risk.