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Predicting reduced bone density after treatment

Chemotherapy and radiotherapy treatments are toxic for cancer cells, but they are not good for healthy cells either. The treatments increase the probability of patients with childhood cancer experiencing side effects years after they have been cured, such as reduced bone density. Jenneke van Atteveld and colleagues developed a model to predict bone density.
Specialists at the LATER outpatient clinic check whether survivors of childhood cancer experience subsequent effects of the cancer treatment. One possible side effect is reduced bone density, which increases the probability of fractures and collapsed vertebrae. “It’s important to know whether or not the bone density is reduced, as a healthy diet, getting enough exercise and sometimes even medication can make a difference,” says Jenneke van Atteveld, doctor and researcher at the Princess Máxima Center.

DXA scan
In order to ascertain whether bone density is reduced, a DXA (dual-energy X-ray absorptiometry) scan is required. “Although the scan is non-invasive, we don’t want to put survivors through anything that isn’t necessary. Health insurers too are calling for a better selection model, because the process obviously costs money,” says Jenneke.

Prediction model
In order to estimate the extent of the risk of reduced bone density, Jenneke and colleagues from the Princess Máxima Center (Saskia Pluijm, Sebastian Neggers and Marry van den Heuvel-Eibrink), the Erasmus University Medical Center and the St. Jude Children’s Research Hospital in Memphis developed a prediction model and a toolkit. Jenneke: “The toolkit enables oncologists from the LATER outpatient clinic to estimate the extent of the risk of reduced bone density on the basis of a few details, such as sex, age, height, weight and treatment history. The toolkit advises the doctor on whether or not to perform a DXA scan.” In future, using the toolkit could prevent unnecessary stress for former patients and drive down the associated costs if it is included in LATER’s healthcare guidelines.


Jenneke and her colleagues published an article on this in the Journal of Clinical Oncology. The toolkit is intended for healthcare providers and can be used via this link: https://riskcalculator-bonemineraldensity-childhoodcancer.azurewebsites.net/