Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: recommendations from the international late effects of childhood cancer guideline harmonization group (IGHG)

Abstract

Background and Aims:Childhood,adolescentandyoungadult(CAYA)cancersurvivorsareatincreasedriskof(very)lowbonemineralden-sity(BMD).Clinicalpracticesurveillanceguidelinesareimportantfortimelydiagnosisandtreatmentofthesesurvivors,whichcouldimproveBMDparametersandpreventfragilityfractures.Discordancesacrosscurrentlate-effectsguidelinesnecessitatedinternationalharmoniza-tionofBMDsurveillancerecommendations.Methods:TheIGHGestablishedapanelof36expertsfrom10coun-tries,representingarangeofrelevantmedicalspecialties.Theevidenceofriskfactorsforlow(Z-score≤-1)andverylow(Z-score≤-2)BMDandfractures,surveillancemodality,timingofBMDsurveillance,andtreatmentof(very)lowBMDwereevaluatedandcriticallyappraised,and harmonized recommendations for CAYA cancer survivors wereformulated.Wegradedtherecommendationsbasedonthequalityofunderlyingevidenceandthebalancebetweenpotentialbenefitsandharms.Results:BMDsurveillanceisrecommendedforsurvivorstreatedwithcranial or craniospinal radiotherapy, and is reasonable for survivorstreated with total body irradiation. Due to insufficient evidence, norecommendationcanbeformulatedfororagainstBMDsurveillancefor survivors treated with corticosteroids. This surveillance decisionshouldbemadebythesurvivorandhealthcareprovidertogether,aftercareful consideration of the potential harms and benefits and addi-tionalriskfactors.WerecommendtoperformBMDsurveillanceusingdual-energy X-ray absorptiometry at entry into long-term follow-up(between2-5yearsfollowingtreatmentcessation),andifnormal(Z-score>-1), repeat at 25 years of age when peak bone mass shouldbeachieved.Betweenthesetwomeasurementsandthereafter,BMDsurveillanceshouldbeperformedasclinicallyindicatedbasedonBMDandongoingriskassessment.Conclusions:ThisguidelineprovidesBMDsurveillancerecommenda-tionsthatmayimprovehealthoutcomesbyfacilitatingmoreconsistentcareforCAYAcancersurvivorsinternationally.Inaddition,itpromotesstrategicallyplannedongoingresearchthatwillinformfutureguideline updates.