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  • Clinical Research Article
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Determinants of bone parameters in young paediatric cancer survivors: the iBoneFIT project

Pediatric Research volume 94, pages 1538–1546 (2023)Cite this article

Abstract

Background

Bone health is remarkably affected by endocrine side effects due to paediatric cancer treatments and the disease itself. We aimed to provide novel insights into the contribution of independent predictors of bone health in young paediatric cancer survivors.

Methods

This cross-sectional multicentre study was carried out within the iBoneFIT framework in which 116 young paediatric cancer survivors (12.1 ± 3.3 years old; 43% female) were recruited. The independent predictors were sex, years from peak height velocity (PHV), time from treatment completion, radiotherapy exposure, region-specific lean and fat mass, musculoskeletal fitness, moderate-vigorous physical activity and past bone-specific physical activity.

Results

Region-specific lean mass was the strongest significant predictor of most areal bone mineral density (aBMD), all hip geometry parameters and Trabecular Bone Score (β = 0.400–0.775, p ≤ 0.05). Years from PHV was positively associated with total body less head, legs and arms aBMD, and time from treatment completion was also positively associated with total hip and femoral neck aBMD parameters and narrow neck cross-sectional area (β = 0.327–0.398, p ≤ 0.05; β = 0.135–0.221, p ≤ 0.05), respectively.

Conclusion

Region-specific lean mass was consistently the most important positive determinant of all bone parameters, except for total hip aBMD, all Hip Structural Analysis parameters and Trabecular Bone Score.

Impact

  • The findings of this study indicate that region-specific lean mass is consistently the most important positive determinant of bone health in young paediatric cancer survivors.

  • Randomised clinical trials focused on improving bone parameters of this population should target at region-specific lean mass due to the site-specific adaptations of the skeleton to external loading following paediatric cancer treatment.

  • After paediatric cancer diagnosis, years from peak height velocity (somatic maturity) is critical for bone development.

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Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to the fact that the iBoneFIT project has not finished yet but are available from the corresponding author on reasonable request.

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Acknowledgements

Herein, we would like to thank the disposal and consideration of all families involved in the investigation. The authors of this manuscript certify that they comply with the ethical guidelines for authorship and publishing in the Pediatric Research. The corresponding author affirms that all authors have contributed significantly to the work.

Funding

This study has been partially supported by the Spanish Ministry of Science and Innovation (ref: PID2020-117302RA-I00 financiado por MCIN/ AEI /10.13039/501100011033), La Caixa Foundation (ref: LCF/BQ/PR19/11700007), the University of Granada Plan Propio de Investigación 2021-Excellence actions: Unit of Excellence on Exercise, Nutrition and Health (UCEENS) and the CIBEROBN, Centro de Investigación Biomédica en Red (CB22/03/00058), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – European Regional Development Fund. A.M.-P. is the recipient of a predoctoral fellowship (FPU20/05530) by the Spanish Ministry of Education, Culture and Sport. E.U.-G. is supported by the Maria Zambrano fellowship by the Ministerio de Universidades y la Unión Europea—NextGenerationEU.

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Authors and Affiliations

  1. Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain

    Andres Marmol-Perez, Esther Ubago-Guisado, Andrea Rodriguez-Solana, Jose J. Gil-Cosano, Jonatan R. Ruiz & Luis Gracia-Marco

  2. Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain

    Esther Ubago-Guisado, Jonatan R. Ruiz & Luis Gracia-Marco

  3. Instituto de Investigación Biomédica Maimonides (IMIBIC), Córdoba, España

    Francisco J. Llorente-Cantarero

  4. CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Francisco J. Llorente-Cantarero, Jonatan R. Ruiz & Luis Gracia-Marco

  5. Departamento de Didácticas Específicas, Facultad de Educación, Universidad de Córdoba, Córdoba, España

    Francisco J. Llorente-Cantarero

  6. Centro de Investigación sobre Ejercicio y Salud Infantil, Universidad de Exeter, Exeter, UK

    Dimitris Vlachopoulos

  7. Department of Communication and Education, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain

    Jose J. Gil-Cosano

Authors
  1. Andres Marmol-Perez
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  2. Esther Ubago-Guisado
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  5. Andrea Rodriguez-Solana
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  8. Luis Gracia-Marco
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Contributions

A.M.-P., F.J.L.-C., E.U.-G., A.R.-S., J.J.G.-C., J.R.R. and L.G.-M. coordinated the study sites, including participant recruitment. A.M.-P., E.U.-G., A.R.-S., J.J.G.-C. and L.G.-M. wrote all the protocol versions, and obtained ethical approval and funding. L.G.-M. was the principal investigator. A.M.-P., F.J.L.-C., E.U.-G., A.R.-S., J.J.G.-C. and L.G.-M. were responsible for data collection, including clinical data. A.M.-P. conceptualised and designed the study with the support of E.U.-G., D.V. and L.G.-M. A.M.-P. drafted the initial manuscript and all co-authors were involved in the interpretation of data, revised the manuscript and approved the final manuscript as submitted.

Corresponding author

Correspondence to Esther Ubago-Guisado.

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Marmol-Perez, A., Ubago-Guisado, E., Llorente-Cantarero, F.J. et al. Determinants of bone parameters in young paediatric cancer survivors: the iBoneFIT project. Pediatr Res 94, 1538–1546 (2023). https://doi.org/10.1038/s41390-023-02645-8

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