Assessment of bone health in children and adolescents with cancer: promises and pitfalls of current techniques.

During childhood and adolescence, skeletal development is characterized by gender-, face-, and maturation-specific increases in cortical dimensions and trabecular density. Children with cancer have multiple risk factors for impuired bone mineralization, including delayed growth and maturation, sex hormone deficiencies, decreasal physical activity and biomechanical loading of the skeleton, glucocorticoid and other immunosuppressive therapies, growth hormone deficiency, and malnutrition. This review outlines the expected gains in bone dimensions, mineral content and strength during childhood and adolescence. Varied threats to bone health in the child with cancer are summarized, with special attention to potential effects on bone formation and resorption in the growing skeleton. The strengths and limitations of dual energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) techniques in the assessment of the different disease-related effects on bone strength are discussed, and alternative analytic approaches explored.