Impaired bone health after pediatric acute lymphoblastic leukemia treatment despite normal DXA: insights from high-resolution peripheral quantitative computed tomography

Introduction Acute lymphoblastic leukemia (ALL) is the most common cancer in childhood. With improved survival rates, more attention has turned to long-term outcomes such as bone health. High-resolution peripheral quantitative computed tomography (HR-pQCT) allows a three-dimensional assessment of cortical and trabecular bone and may have advantages over standard dual-energy X-ray absorptiometry (DXA). The aim of this study was to evaluate whether HR-pQCT can detect early bone health impairment in children following ALL treatment. Methods In this cross-sectional study, HR-pQCT findings in children within 5 years after completion of ALL therapy were compared with healthy controls. Additional assessments for ALL patients included lumbar spine bone mineral density (LSBMD) assessed by DXA and vertebral fracture (VF) assessment using EOS. Results HR-pQCT data from 30 ALL patients (14 male patients; median age 8.8 years) and 64 healthy controls (30 male controls; median age 9.4 years) were analyzed. Five ALL patients (17%) showed evidence of one or more VFs. LSBMD z-scores were within the normal range for all patients (mean 0.09 SDS). Compared with healthy controls, children after ALL treatment showed significantly reduced cortical area (p = 0.013), cortical BMD (p = 0.001), and cortical thickness (p = 0.006) at the tibia, and reduced cortical area (p = 0.046) and cortical BMD (p = 0.008) at the radius on HR-pQCT. Conclusion Despite normal LSBMD DXA z-scores, a substantial proportion of pediatric ALL patients had vertebral fractures and lower values for several cortical parameters at both the radius and tibia on HR-pQCT. These findings suggest that HR-pQCT may serve as a valuable adjunctive tool to detect bone health impairment in children after ALL treatment.