Diminished Bone Mineral Density in Survivors of Childhood Acute Lymphoblastic Leukemia (ALL): A Severity-Adapted Clinical Trial
The main objectives of the study are:
- To estimate, using quantitative computed tomography (QCT), the prevalence of diminished
bone mineral density (BMD) in patients treated with contemporary, protocol-based
multiagent chemotherapy (+cranial irradiation) for childhood acute lymphoblastic
- To investigate possible risk factors for the development of diminished BMD in patients
treated with contemporary protocol-based therapy for childhood ALL. Factors to be
examined include patient characteristics (age at the time of treatment, gender, race,
body mass index, physical activity and nutritional status, menarchal status, oral
contraceptive use, growth hormone therapy, smoking and alcohol intake, birth weight,
fracture history); treatment effects (intensity of treatment with antimetabolites and
glucocorticoids; history of cranial irradiation); and genetic predisposition (i.e.,
vitamin D and CYP3A4 receptor polymorphism and family history of osteoporosis).
- To evaluate, in a prospective placebo-controlled double-blinded randomized trial, the
effects of vitamin D and calcium supplementation in addition to nutritional counseling
on BMD in patients with BMD scores below the mean for age- and gender-matched controls,
compared to an educational program of nutritional counseling alone.
- To evaluate, in a prospective randomized trial, the correlation between BMD as
determined by QCT and BMD as determined by dual energy x-ray absorptiometry (DEXA) in
patients with BMD more than one standard deviation (SD) below the mean for age- and
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
Effect of Taking Calcium and Vitamin D Supplements on Bone Mineral Density (BMD)
The effect of taking calcium and vitamin D supplements was measured using Quantitative Computed Tomography (QCT) to calculate a QTC Z score. A standardized Z-score was calculated to indicate the difference between the patient's Bone Mineral Density (BMD) and the mean value for age and gender-appropriate controls. Z-scores from 0 to +2 are considered normal, above +2 are considered to be elevated, from 0 to -1 are considered to represent a mild BMD deficit, between -1 and -2 are considered to represent moderate deficits, and below -2 are considered to represent severe deficits.
Sue C. Kaste, D.O.
St. Jude Children's Research Hospital
United States: Institutional Review Board
|St. Jude Children's Research Hospital||Memphis, Tennessee 38105-2794|
|Metabolic Bone Center at the University of Tennessee||Memphis, Tennessee 38163|
|Preventive Medicine, University of Tennessee||Memphis, Tennessee 38163|