Bone mineral density and vertebral fractures in teenage and young adult patients with acute lymphoblastic leukaemia and lymphoblastic lymphoma: A report from the British OsteoNecrosis Study (BONES)

The British Osteonecrosis Study (BONES) is the first multicentre prospective study assessing bone health and vertebral fractures in patients aged 10–24 in the United Kingdom undergoing treatment for acute lymphoblastic leukaemia (ALL) or lymphoblastic lymphoma (LBL). Sixty-one patients were recruited from three tertiary centres in the United Kingdom. Dual-energy X-ray absorptiometry (DXA) scans with vertebral fracture analysis were performed within 4 weeks of diagnosis and annually for 3 years. Subjective pain assessments were performed at the same time points. Bone mineral density (assessing total body less head (TBLH)) significantly reduced after 2 years, compared to baseline (estimate = −0.964, 95% CI [−1.357, −0.572]), with the greatest decrease occurring within the first year. Vertebral fracture prevalence was 4.9%, with two further patients experiencing incident vertebral fractures. All vertebral fractures occurred in male patients, 75% of whom were British Asian. Back pain was not a predictor of low bone mineral density (BMD) or vertebral fractures. We report a lower vertebral fracture prevalence in patients aged 10–24 with ALL than has been previously reported in a cohort of younger patients. Male British Asian patients appeared to be at higher risk of vertebral fractures in our study. BMD and pain were not predictors of vertebral fractures.