One Year Research Update:
Researchers and physicians know that children who undergo cancer treatment are at risk for decreased bone mineral density because many cancer treatments negatively affect bone health. It is particularly important that children and adolescents develop strong bone density because bone strength decreases in adulthood. Despite this knowledge, little is known about the rate at which fractures actually occur in survivors of childhood cancer and if they can be prevented.
Lynda Vrooman, MD, MMSc of Dana-Farber Cancer Institute is a CureSearch Young Investigator interested in better defining the risks and long-term consequences of fracture in survivors of childhood cancer, and in intervening to minimize long-term complications. During her first year of research, Dr. Vrooman completed enrollment of 193 patients in a study of reported bone fracture. Her findings demonstrate that approximately 25% of cancer survivors experienced at least one fracture after cancer treatment. Of those with fracture, 35% experienced more than one fracture after treatment. In addition, survivors treated with corticosteroids, commonly used in the treatment of many types of children’s cancer, experienced significantly higher rates of fracture after cancer treatment. These results highlight the importance of minimizing the bony complications associated with corticosteroids and suggest that a treatment-associated fracture risk may extend beyond cancer therapy completion.
In the next year of her work, Dr. Vrooman will conduct detailed bone density testing in childhood cancer survivors with a history of fracture. Dr. Vrooman anticipates that this work will inform future interventional studies aimed at decreasing skeletal toxicity in survivors of childhood cancer.
Skeletal toxicities in pediatric and adolescent cancer survivors are recognized as serious complications of therapy for childhood cancers. Exposures during cancer therapy in childhood and adolescence can jeopardize the accumulation of bone mass, and potentially have long-term impact on bone health in survivors, including an increased risk of bone fracture and low mineral density. Bone mineral density (BMD) is a measure of a bone’s strength and it is important for children and adolescents to have strong bones because bone strength does not increase in the adult years. While physicians and researchers know that certain therapies commonly used in treating childhood cancer, such as steroids, can lead to low bone mineral density and skeletal toxicity, little is known about the rate of fracture occurrence in long-term follow-up, if fractures can be prevented, and about the long-term bone health of childhood cancer survivors.
Lynda Vrooman, MD, MMSc of Dana-Farber Cancer Institute is interested in better defining the risks and long-term consequences of fracture in survivors of childhood cancer, and in intervening to minimize long-term complications. Through Project REACH, a prospective study of childhood cancer survivors, Dr. Vrooman will evaluate survivors at least 2 years post treatment in order to determine the frequency of bone fractures, related risk factors, as well as survivors’ self reporting of physical function and levels of pain.
Based on these results, Dr. Vrooman will conduct detailed evaluations of bone mineral density, bone geometry, and bone strength in childhood cancer survivors who experience fracture after treatment. Tests of bone mineral density measure the mineral content of bone. Through these investigations, Dr. Vrooman hopes that a detailed understanding of skeletal composition in patients with a history of fracture will inform future interventional studies aimed at reducing skeletal toxicity.
Based on her findings, Dr. Vrooman hopes to contribute to understanding, reducing, and preventing bone fracture in childhood cancer survivors.