Skeletal morbidity from the treatment of cancer in children. Loss of mineral mass and avascular necrosis of bone

Skeletal morbidity is a common sequel to the treatment of cancer in childhood, and adolescents are especially vulnerable. Glucocorticosteroids are important causal factors in both avascular necrosis and loss of mineral mass (osteopenia). Additional contributors to osteopenia are other anti-neoplastic drugs, especially methotrexate, growth hormone deficiency from cranial irradiation, and reduced physical activity. Consequent impairment of peak bone mass results in an increased risk of fractures in the short-term as well as in later life. Pediatricians and others caring for such survivors need to be aware of these adverse outcomes and engage in health promotion in addition to pharmacological intervention.