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Peer-reviewedCC BY 4.0Frontiers in Endocrinology

Longitudinal changes in bone mineral density, bone turnover markers, and body composition in children and adolescents treated for acute lymphoblastic leukemia

  • Alessandro Cattoni1
  • Silvia Molinari1
  • Giulia Capitoli2,3
  • Silvia Vai4
  • Silvia Carrara4
  • Emanuela Galliera5,6
  • Luca Massaccesi5,6
  • Maria Laura Nicolosi1
  • Silvia Radaelli7
  • Martina Sarra7
  • Daniele Tondelli3
  • Rocco Corso8
5 more authors
  • Giovanni Speziali8
  • Andrea Biondi1,7
  • Adriana Balduzzi1,7
  • Sabrina Corbetta4,9
  • Alessandra Sala1
9 affiliations
  1. 1Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori
  2. 2Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo dei Tintori
  3. 3Bicocca Bioinformatics, Biostatistics and Bioimaging B4 Centre, Department of Medicine and Surgery, University of Milano-Bicocca
  4. 4UOS Bone Metabolic Diseases and Diabetes, IRCCS Istituto Auxologico Italiano
  5. 5Department of Biomedical Sciences for Health, University of Milan
  6. 6IRCCS Ospedale Galeazzi-Sant’Ambrogio
  7. 7School of Medicine and Surgery, University of Milano-Bicocca
  8. 8Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori
  9. 9Department of Biomedical, Surgical and Dental Sciences, University of Milan
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Abstract

Purpose: Impaired bone mineral density (BMD) is a common finding in young patients with acute lymphoblastic leukemia (ALL). Nevertheless, longitudinal trendlines of BMD and the impact of body composition (BC) on bone health still need to be explored among pediatric survivors. The objective of the study is to report longitudinal changes in BMD and BC in pediatric patients.

Methods: This prospective, longitudinal study, collecting BMD and BC (assessed by dual-energy X-ray absorptiometry [DXA]) and circulating bone turnover markers every 6 months for 3 years, from diagnosis of ALL (T ₀ ) until 1 year after the end of antiblastic treatment (T ₆ ).

Results: Forty-nine patients were enrolled. At T ₀ , lumbar spine (LS-)BMD Z-score was ≤−2.0 in 71.7% of patients [median: −2.8 (−3.5, −1.9)], possibly reflecting trabecular bone infiltration by lymphoblasts. Conversely, total body less than head (TBLH)-BMD Z-score was >−2.0 in 97.8% of patients at T ₀ but abruptly declined after 6 months ( p < 0.001). Despite a recovery trend after the end of treatment, LS or TBLH-BMD Z-scores were still <−2.0 in 67.7% of the 31 patients still enrolled at T ₆ . Bone turnover was increased between T ₁ and T ₄ . Lean mass decreased over time, while fat mass progressively increased. Multivariable analysis showed a statistically significant association between appendicular lean mass longitudinal recovery over time and T ₁ –T ₆ TBLH-BMD trendlines ( p = 0.008).

Conclusions: In pediatric patients, LS-BMD is remarkably affected at diagnosis of ALL. TBLH-BMD, normal at diagnosis, promptly declines during treatment and baseline values are not retrieved after 36 months. Lean mass is positively associated with longitudinal improvements of subtotal BMD over time.

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Cite

BibTeXRIS
BibTeX
@article{cattoni2026longitudinal,
  title = {{Longitudinal changes in bone mineral density, bone turnover markers, and body composition in children and adolescents treated for acute lymphoblastic leukemia}},
  author = {Alessandro Cattoni and Silvia Molinari and Giulia Capitoli and Silvia Vai and Silvia Carrara and Emanuela Galliera and Luca Massaccesi and Maria Laura Nicolosi and Silvia Radaelli and Martina Sarra and Daniele Tondelli and Rocco Corso and Giovanni Speziali and Andrea Biondi and Adriana Balduzzi and Sabrina Corbetta and Alessandra Sala},
  journal = {Frontiers in Endocrinology},
  year = {2026},
  month = oct,
  doi = {10.3389/fendo.2026.1901073},
  url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1901073/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Longitudinal changes in bone mineral density, bone turnover markers, and body composition in children and adolescents treated for acute lymphoblastic leukemia
AU  - Alessandro Cattoni
AU  - Silvia Molinari
AU  - Giulia Capitoli
AU  - Silvia Vai
AU  - Silvia Carrara
AU  - Emanuela Galliera
AU  - Luca Massaccesi
AU  - Maria Laura Nicolosi
AU  - Silvia Radaelli
AU  - Martina Sarra
AU  - Daniele Tondelli
AU  - Rocco Corso
AU  - Giovanni Speziali
AU  - Andrea Biondi
AU  - Adriana Balduzzi
AU  - Sabrina Corbetta
AU  - Alessandra Sala
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in Endocrinology
DO  - 10.3389/fendo.2026.1901073
UR  - https://www.frontiersin.org/articles/10.3389/fendo.2026.1901073/full
AB  - Purpose: Impaired bone mineral density (BMD) is a common finding in young patients with acute lymphoblastic leukemia (ALL). Nevertheless, longitudinal trendlines of BMD and the impact of body composition (BC) on bone health still need to be explored among pediatric survivors. The objective of the study is to report longitudinal changes in BMD and BC in pediatric patients.  Methods: This prospective, longitudinal study, collecting BMD and BC (assessed by dual-energy X-ray absorptiometry [DXA]) and circulating bone turnover markers every 6 months for 3 years, from diagnosis of ALL (T ₀ ) until 1 year after the end of antiblastic treatment (T ₆ ).  Results: Forty-nine patients were enrolled. At T ₀ , lumbar spine (LS-)BMD Z-score was ≤−2.0 in 71.7% of patients [median: −2.8 (−3.5, −1.9)], possibly reflecting trabecular bone infiltration by lymphoblasts. Conversely, total body less than head (TBLH)-BMD Z-score was >−2.0 in 97.8% of patients at T ₀ but abruptly declined after 6 months ( p < 0.001). Despite a recovery trend after the end of treatment, LS or TBLH-BMD Z-scores were still <−2.0 in 67.7% of the 31 patients still enrolled at T ₆ . Bone turnover was increased between T ₁ and T ₄ . Lean mass decreased over time, while fat mass progressively increased. Multivariable analysis showed a statistically significant association between appendicular lean mass longitudinal recovery over time and T ₁ –T ₆ TBLH-BMD trendlines ( p = 0.008).  Conclusions: In pediatric patients, LS-BMD is remarkably affected at diagnosis of ALL. TBLH-BMD, normal at diagnosis, promptly declines during treatment and baseline values are not retrieved after 36 months. Lean mass is positively associated with longitudinal improvements of subtotal BMD over time.
SN  - 1664-2392
ER  -