On this page you can find:

• Who is at risk for bone problems?
• What bone problems might occur?
• What surveillance modality should be used and at what frequency should it be performed?
• What other advice should be given?
• What should be done if abnormalities are identified?

Who is at risk for bone problems?

CAYA cancer survivors treated with or with a history of

• prolonged corticosteroids as anti-cancer treatment ^b
• methotrexate
• HSCT, especially with any history of GvHD
• TBI
• cranial and/or spinal radiotherapy
• high dose radiotherapy
• gonadal failure
• growth hormone deficiency

What bone problems might occur?

• Reduced bone mineral density (after prolonged corticosteroids as anti-cancer treatment ^b, methotrexate, HSCT, especially with any history of GvHD, TBI, cranial and/or spinal radiotherapy, gonadal failure or growth hormone deficiency
• Osteonecrosis (after prolonged corticosteroids as anti-cancer treatment ^b, HSCT, especially with any history of GvHD or high dose radiotherapy)

What surveillance modality should be used and at what frequency should it be performed?

Survivors at risk for osteonecrosis:

• A history for symptoms of osteonecrosis
  at least every 5 years, starting at entry into long-term follow-up

Survivors at risk for reduced bone mineral density:

• A history with specific attention to risk factorsc and symptoms (back pain, fractures) of reduced bone mineral density
  at least every 5 years, starting at entry into long-term follow-up
• A DXA scan ^d once, if possible, and thereafter as clinically indicated

What other advice should be given?

Survivors at risk for reduced bone mineral density:

• Recommend adequate calcium and vitamin D intake, and adequate physical activity according to guidelines for the general population

What should be done if abnormalities are identified?

• Refer to an endocrinologist (for osteoporosis)
• Suspicion of osteonecrosis should always be followed by a timely referral to an orthopaedic surgeon

Disclaimer

While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.