الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Introduction: The bone health of children with ALL is an increasing medical concern. Improved childhood ALL survival of makes the vision of modern treatment protocols to cure cancer and to improve quality of life. Aim To determine whether bisphosphonate use-zoledronic acid-lead to the prevention of secondary osteoporosis and osteonecrosis in children and adolescents treated for ALL versus the use of calcium plus alfa calcidol supplementation alone. Material and methods: Newly diagnosed, previously untreated children with ALL aged more than 5 years and below 18 years (N=131) were randomized to receive calcium plus alfa calcidol alone (arm A, N=68) or to receive zoledronic acid in addition (arm B, N=63). DXA scan at baseline and at week 48 of maintenance of the St Jude Total study XV protocol was done for BMD assessment. Pain score analysis, fracture incidence and the occurrence of avascular necrosis were documented. Results: There was a significant increase in BMD values compared to baseline in both groups at week 48. Arm A showed increase in BMD from (0.676+/- 0.19) g/cm2 to (0.729+/-0.17) g/cm2 (p 0.005). Arm B had a change in BMD from (0.677+/- 0.169) g/cm2 to (0.793+/-0.13) g/cm2 (p <0.001). BMD at end of treatment varied significantly from baseline in arm A (p-value 0.002) as well as in arm B (p-value 0.004). No significant difference between both arms at week 48 and end of treatment (p 0.077 and 0.155) respectively, however, more than 90% of patients who had significantly lower BMD Z-scores at baseline continued to be significantly lower at week 48 compared to 65% in arm B (p 0.032). At end of treatment, >80% in arm A continued to have significantly lower values, compared to 58.3% of patients in arm B p 0.675