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Acute Lymphoblastic Leukemia Research / Childhood Cancer Survivors' Quality of Life · Journal article
Frontiers in Endocrinology · September 7, 2026
Encouraging direction, but not yet definitive.
This cross-sectional study finds that pediatric ALL survivors have significantly reduced cortical bone parameters on HR-pQCT imaging despite normal lumbar spine bone mineral density on DXA, and 17% have evidence of vertebral fractures. The findings suggest HR-pQCT may detect bone microarchitecture defects not apparent on standard DXA, but confirmation in larger prospective studies is needed before clinical implementation.
Cross-sectional comparative study. Children within 5 years after completion of ALL therapy (ALL cohort) compared with healthy controls; both groups recruited from a single center (implied from study structure). Key eligibility criteria not explicitly stated.. Intervention: High-resolution peripheral quantitative computed tomography (HR-pQCT) imaging of tibia and radius; dual-energy X-ray absorptiometry (DXA) of lumbar spine; EOS vertebral fracture assessment. Compared with: Healthy age-matched controls without cancer history. n = 94.
Cortical area reduced at tibia (p = 0.013) and radius (p = 0.046) in ALL patients versus controls Cortical BMD significantly reduced at tibia (p = 0.001) and radius (p = 0.008) Cortical thickness reduced at tibia (p = 0.006)
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This study suggests that standard DXA screening may miss bone microarchitecture defects in pediatric ALL survivors who appear to have normal bone mineral density. Clinicians evaluating bone health in this population should consider whether HR-pQCT or other imaging modalities that assess bone quality might identify patients at risk for fractures despite normal DXA results.
A cross-sectional study using advanced imaging (HR-pQCT) to detect bone health impairment missed by standard DXA in pediatric ALL survivors; real findings in a limited sample that warrant confirmation in larger, prospective cohorts.
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This study suggests that standard DXA screening may miss bone microarchitecture defects in pediatric ALL survivors who appear to have normal bone mineral density. Clinicians evaluating bone health in this population should consider whether HR-pQCT or other imaging modalities that assess bone quality might identify patients at risk for fractures despite normal DXA results.
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Introduction Acute lymphoblastic leukemia (ALL) is the most common cancer in childhood. With improved survival rates, more attention has turned to long-term outcomes such as bone health. High-resolution peripheral quantitative computed tomography (HR-pQCT) allows a three-dimensional assessment of cortical and trabecular bone and may have advantages over standard dual-energy X-ray absorptiometry (DXA). The aim of this study was to evaluate whether HR-pQCT can detect early bone health impairment in children following ALL treatment. Methods In this cross-sectional study, HR-pQCT findings in children within 5 years after completion of ALL therapy were compared with healthy controls. Additional assessments for ALL patients included lumbar spine bone mineral density (LSBMD) assessed by DXA and vertebral fracture (VF) assessment using EOS. Results HR-pQCT data from 30 ALL patients (14 male patients; median age 8.8 years) and 64 healthy controls (30 male controls; median age 9.4 years) were analyzed. Five ALL patients (17%) showed evidence of one or more VFs. LSBMD z-scores were within the normal range for all patients (mean 0.09 SDS). Compared with healthy controls, children after ALL treatment showed significantly reduced cortical area (p = 0.013), cortical BMD (p = 0.001), and cortical thickness (p = 0.006) at the tibia, and reduced cortical area (p = 0.046) and cortical BMD (p = 0.008) at the radius on HR-pQCT. Conclusion Despite normal LSBMD DXA z-scores, a substantial proportion of pediatric ALL patients had vertebral fractures and lower values for several cortical parameters at both the radius and tibia on HR-pQCT. These findings suggest that HR-pQCT may serve as a valuable adjunctive tool to detect bone health impairment in children after ALL treatment.
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