Skeletal toxicities of treatment in children with cancer.

For many childhood cancer survivors, the future will hold years of pain and disability due to skeletal toxicities resulting from disease, its treatment and predisposing familial factors that contribute to the development of bone mineral density (BMD) deficits and osteonecrosis. Some technical limitations of imaging methods designed to assess BMD in skeletally mature adult patients are amplified when used to assess bone density in growing children and adolescents. Identifying changes in bone marrow that are associated with disease or treatment, and differentiating these that may heal in comparison to those likely to progress, have not been studied extensively in children. Until recently, little emphasis has been placed on the definition, characterization and prospective monitoring of these two major skeletal toxicities in pediatric patients, despite the growing attention being paid to the prevalence and severity of osteoporosis in adults. Further, the disease definitions established for adults are unlikely to apply to growing children. This presentation will discuss many of the issues related to defining, identifying, and classifying deficits in BMD and osteonecrosis, and will likely raise more issues than it answers.