Pediatric Endocrinology Diabetes and Metabolism
en POLSKI
eISSN: 2083-8441
ISSN: 2081-237X
Pediatric Endocrinology Diabetes and Metabolism
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Publication charge Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
Search
Editorial Policies
Sarajevo Declaration on Integrity and Visibility of Scholarly Publications

Open access

without publication fees

Journal integrated with

integrated with publons
4/2025
vol. 31
 
Share:
Send email
Share:
Review paper

Chemotherapy-induced osteoporosis in pediatric oncology: pathophysiology and treatment

Jakub Pobideł
1
,
Julia Piekarz
1
,
Natalia Picheta
1
,
Katarzyna Szklener
2

  1. Student Academic Group, Department of Clinical Oncology and Chemotherapy, Medical University, Lublin, Poland
  2. Department of Clinical Oncology and Chemotherapy, Medical University, Lublin, Poland
Pediatr Endocrinol Diabetes Metab 2025; 31 (4): 187-194
DOI: https://doi.org/10.5114/pedm.2025.158551
Online publish date: 2026/01/27
Article file
- 0398_Chemotherapy-induced.pdf  [0.81 MB]
Get citation
 
PlumX metrics:
 
1. Moon MH, Jo KH, Kim HW. One-stage extra-anatomical total thoracic aortic repair. Eur J Cardiothorac Surg 2015; 47: 938–939. doi: 10.1093/ejcts/ezu289.
2. Bianchi ML. Osteoporosis in children and adolescents. Bone 2007; 41: 486–495. doi: 10.1016/j.bone.2007.07.008.
3. Wade E, Mulholland K, Shaw I, et al. Idiopathic juvenile osteoporosis-a polygenic disorder? JBMR Plus 2024; 8: ziae099. doi: 10.1093/jbmrpl/ziae099.
4. Laine CM, Joeng KS, Campeau PM, et al. WNT1 mutations in early-onset osteoporosis and osteogenesis imperfecta. N Engl J Med 2013; 368: 1809–1816. doi: 10.1056/NEJMoa1215458.
5. Marcucci G, Beltrami G, Tamburini A, et al. Bone health in childhood cancer: review of the literature and recommendations for the management of bone health in childhood cancer survivors. Ann Oncol Off J Eur Soc Med Oncol 2019; 30: 908–920. doi: 10.1093/annonc/mdz120.
6. Chemaitilly W, Cohen LE, Mostoufi-Moab S, et al. Endocrine Late Effects in Childhood Cancer Survivors. J Clin Oncol Off J Am Soc Clin Oncol 2018; 36: 2153–2159. doi: 10.1200/JCO.2017.76.3268.
7. Ciancia S, van Rijn RR, Högler W, et al. Osteoporosis in children and adolescents: when to suspect and how to diagnose it. Eur J Pediatr 2022; 181: 2549–2561. doi: 10.1007/s00431-022-04455-2.
8. Thomas IH, Donohue JE, Ness KK, et al. Bone mineral density in young adult survivors of acute lymphoblastic leukemia. Cancer 2008; 113: 3248–56. doi: 10.1002/cncr.23912.
9. Ward LM. A practical guide to the diagnosis and management of osteoporosis in childhood and adolescence. Front Endocrinol (Lausanne) 2024; 14: 1266986. doi: 10.3389/fendo.2023.1266986.
10. Salari N, Ghasemi H, Mohammadi L, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg 2021; 16: 609. doi: 10.1186/s13018-021-02821-8.
11. Kim JM, Lin C, Stavre Z, et al. Osteoblast-Osteoclast Communication and Bone Homeostasis. Cells 2020; 9: 2073. doi: 10.3390/cells9092073.
12. Adejuyigbe B, Kallini J, Chiou D, Kallini JR. Osteoporosis: Molecular Pathology, Diagnostics, and Therapeutics. Int J Mol Sci 2023; 24: 14583. doi: 10.3390/ijms241914583.
13. Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine 2018; 61: 7–16.  doi: 10.1007/s12020-018-1588-2.
14. Jiang Z, Wang H, Qi G, et al. Iron overload-induced ferroptosis of osteoblasts inhibits osteogenesis and promotes osteoporosis: An in vitro and in vivo study. IUBMB Life 2022; 74: 1052–1069. doi: 10.1002/iub.2656.
15. Bonjour JP, Chevalley T, Ferrari S, Rizzoli R. The importance and relevance of peak bone mass in the prevalence of osteoporosis. Salud Publica Mex 2009; 51 Suppl 1: S5–17.  doi: 10.1590/s0036-36342009000700004.
16. Rizzoli R, Bianchi ML, Garabédian M, et al. Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone 2010; 46: 294–305. doi: 10.1016/j.bone.2009.10.005.
17. van Atteveld JE, Mulder RL, van den Heuvel-Eibrink MM, et al. Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Diabetes Endocrinol 2021; 9: 622–637.  doi: 10.1016/S2213-8587(21)00173-X.
18. Ward LM, Ma J, Lang B, et al. Bone Morbidity and Recovery in Children With Acute Lymphoblastic Leukemia: Results of a Six-Year Prospective Cohort Study. J Bone Miner Res Off J Am Soc Bone Miner Res 2018; 33: 1435–1443.  doi: 10.1002/jbmr.3447.
19. Reilly JJ, Kelly L, Montgomery C, et al. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ 2006; 333: 1041. doi: 10.1136/bmj.38979.623773.55.
20. Vasconcelos C, Sousa P. Effects of Combined Interventions of Physical Activity and Diet in Childhood Cancer Survivors: A Systematic Review. Child Basel Switz 2024; 11: 853. doi: 10.3390/children11070853.
21. Cheung AT, Li WHC, Ho LLK, et al. Impact of brain tumor and its treatment on the physical and psychological well-being, and quality of life amongst pediatric brain tumor survivors. Eur J Oncol Nurs Off J Eur Oncol Nurs Soc 2019; 41: 104–109. doi: 10.1016/j.ejon.2019.06.003.
22. Marmol-Perez A, Ubago-Guisado E, Rodriguez-Solana A, et al. Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis. Front Physiol 2023; 14: 1088740. doi: 10.3389/fphys.2023.1088740.
23. Morales Rodríguez E, Lorenzo Calvo J, Granado-Peinado M, et al. Effects of Exercise Programs on Psychoemotional and Quality-of-Life Factors in Adult Patients with Cancer and Hematopoietic Stem Cell Transplantation or Bone Marrow Transplantation: A Systematic Review. Int J Environ Res Public Health 2022; 19: 15896. doi: 10.3390/ijerph192315896.
24. Inaba H, Cao X, Han A, et al. Bone mineral density in children with acute lymphoblastic leukemia. Cancer 2018; 124: 1025–1035. doi: 10.1002/cncr.31184.
25. Riancho JA, Valero C, Zarrabeitia MT. MTHFR polymorphism and bone mineral density: meta-analysis of published studies. Calcif Tissue Int 2006; 79: 289–293. doi: 10.1007/s00223-006-0143-y.
26. te Winkel ML, van Beek RD, de Muinck Keizer-Schrama SMPF, et al. Pharmacogenetic risk factors for altered bone mineral density and body composition in pediatric acute lymphoblastic leukemia. Haematologica 2010; 95: 752–759. doi: 10.3324/haematol.2009.016303.
27. Rossi F, Tortora C, Paoletta M, et al. Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives. Cancers 2022; 14: 4349. doi: 10.3390/cancers14184349.
28. Nadeau G, Samoilenko M, Fiscaletti M, et al. Predictors of low and very low bone mineral density in long-term childhood acute lymphoblastic leukemia survivors: Toward personalized risk prediction. Pediatr Blood Cancer 2024; 71: e31047. doi: 10.1002/pbc.31047.
29. Sato AY, Richardson D, Cregor M, et al. Glucocorticoids Induce Bone and Muscle Atrophy by Tissue-Specific Mechanisms Upstream of E3 Ubiquitin Ligases. Endocrinology 2017; 158: 664–677. doi: 10.1210/en.2016-1779. 
30. Kobza AO, Herman D, Papaioannou A, et al. Understanding and Managing Corticosteroid-Induced Osteoporosis. Open Access Rheumatol Res Rev 2021; 13: 177–190. doi: 10.2147/OARRR.S282606.
31. Velentza L, Zaman F, Sävendahl L. Bone health in glucocorticoid-treated childhood acute lymphoblastic leukemia. Crit Rev Oncol Hematol 2021; 168: 103492. doi: 10.1016/j.critrevonc.2021.103492.
32. Wong SPY, Mok CC. Management of glucocorticoid-related osteoporotic vertebral fracture. Osteoporos Sarcopenia 2020; 6: 1–7. doi: 10.1016/j.afos.2020.02.002.
33. Redaelli A, Stephens JM, Brandt S, et al. Short- and long-term effects of acute myeloid leukemia on patient health-related quality of life. Cancer Treat Rev 2004; 30: 103–117. doi: 10.1016/S0305-7372(03)00142-7.
34. Uehara R, Suzuki Y, Ichikawa Y. Methotrexate (MTX) Inhibits Osteoblastic Differentiation in Vitro: Possible Mechanism of MTX Osteopathy. J Rheumatol 2001; 28: 251–256. 
35. Gharibi S, Alizadeh A, Saki Malehi A, Rahim F. Methotrexate-induced toxicities in children with malignancy: a systematic review and meta-analysis. World Cancer Res J [Internet] 2021; 8 : e2041. doi: 10.32113/wcrj_20217_2041.
36. Jørgensen AP, Bollerslev J. Bone: Growth hormone replacement-implications for bone health. Nat Rev Endocrinol 2012; 8: 325–326. doi: 10.1038/nrendo.2012.50.
37. van Santen HM, Chemaitilly W, Meacham LR, et al. Endocrine Health in Childhood Cancer Survivors. Pediatr Clin North Am 2020; 67: 1171–1186. doi: 10.1016/j.pcl.2020.08.002.
38. Updated-PanCareFollowUp-Recommendations-for-long-term-follow-up-April-2024_Final-3.0.pdf [Internet]. Available at: https://www.pancare.eu/wp-content/uploads/2025/02/Updated-PanCareFollowUp-Recommendations-for-long-term-follow-up-April-2024_Final-3.0.pdf.
39. Bouftas F, DeVries C. Vitamin D and pediatric bone health: Important information and considerations for the pediatric orthopaedic surgeon. J Pediatr Soc North Am 2024; 7: 100042. doi: 10.1016/j.jposna.2024.100042.
40. Li K, Guo C, Yin Y, et al. Association between dietary vitamin B12 intake and bone mineral density in adolescents. Pediatr Res 2025. doi: 10.1038/s41390-025-04150-6.
41. Munns C. Treatment of childhood osteoporosis – current and future perspectives. Int J Pediatr Endocrinol 2015; 2015 (Suppl 1): O11. doi: 10.1186/1687-9856-2015-S1-O11.
42. Saraff V, Sahota J, Crabtree N, et al. Efficacy and treatment costs of zoledronate versus pamidronate in paediatric osteoporosis. Arch Dis Child 2018; 103: 92–94. doi: 10.1136/archdischild-2017-313234.
43. Chen Q, Shen P, Zhang B, et al. The role of neridronate in the management of osteoporosis: A meta-analysis. Adv Clin Exp Med 2024; 33: 5–12. doi: 10.17219/acem/162921.
44. The Role of Bisphosphonates in Pediatric Orthopaedics: What Do We Know After 50 Years? ScienceDirect [Internet]. Available at: https://www.sciencedirect.com/science/article/pii/S2768276524001500.
45. Kobayakawa T, Miyazaki A, Takahashi J, Nakamura Y. Verification of efficacy and safety of ibandronate or denosumab for postmenopausal osteoporosis after 12-month treatment with romosozumab as sequential therapy: The prospective VICTOR study. Bone 2022; 162: 116480. doi: 10.1016/j.bone.2022.116480.
46. Anastasilakis AD, Polyzos SA, Makras P, et al. Clinical Features of 24 Patients With Rebound-Associated Vertebral Fractures After Denosumab Discontinuation: Systematic Review and Additional Cases. J Bone Miner Res Off J Am Soc Bone Miner Res 2017; 32: 1291–1296. doi: 10.1002/jbmr.3110.
47. McClung MR. Sclerostin antibodies in osteoporosis: latest evidence and therapeutic potential. Ther Adv Musculoskelet Dis 2017; 9: 263–270. doi: 10.1177/1759720X17726744.
48. Cheung AT, Li WHC, Ho LLK, et al. Physical activity for pediatric cancer survivors: a systematic review of randomized controlled trials. J Cancer Surviv Res Pract 2021; 15: 876–889. doi: 10.1007/s11764-020-00981-w.
49. Faienza MF, Giardinelli S, Annicchiarico A, et al. Nutraceuticals and Functional Foods: A Comprehensive Review of Their Role in Bone Health. Int J Mol Sci 2024; 25: 5873. doi: 10.3390/ijms25115873.
50. Pérez-Pitarch A, Guglieri-López B, Nacher A, et al. Impact of Undernutrition on the Pharmacokinetics and Pharmacodynamics of Anticancer Drugs: A Literature Review. Nutr Cancer 2017; 69: 555–563. doi: 10.1080/01635581.2017.1299878.
51. Monagel DA, Albaity AO, Asiri FM, et al. Vitamin D Deficiency in Pediatric Oncology Patients: A Single-Center Experience in Saudi Arabia. Cureus 2024; 16: e54807. doi: 10.7759/cureus.54807.
52. van Atteveld JE, Verhagen IE, van den Heuvel-Eibrink MM, et al. Vitamin D supplementation for children with cancer: A systematic review and consensus recommendations. Cancer Med 2021; 10: 4177–4794. doi: 10.1002/cam4.4013.
53. Peng H, Qiu X, Cheng M, et al. Resveratrol-loaded nanoplatform RSV@DTPF promote alveolar bone regeneration in OVX rat through remodeling bone-immune microenvironment. Chem Eng J 2023; 476: 146615. doi. 10.1016/j.cej.2023.146615.
54. Marin GE, Neag MA, Burlacu CC, Buzoianu AD. The Protective Effects of Nutraceutical Components in Methotrexate-Induced Toxicity Models – An Overview. Microorganisms 2022; 10: 2053. doi: 10.3390/microorganisms10102053.
55. Rossi F, Tortora C, Punzo F, et al. The Endocannabinoid/Endovanilloid System in Bone: From Osteoporosis to Osteosarcoma. Int J Mol Sci 2019; 20: 1919. doi: 10.3390/ijms20081919.
56. Bellini G, Di Pinto D, Tortora C, et al. The Role of Mifamurtide in Chemotherapy-induced Osteoporosis of Children with Osteosarcoma. Curr Cancer Drug Targets 2017; 17: 650–656. doi: 10.2174/1568009616666161215163426.
57. Lee AMC, Shandala T, Soo PP, et al. Effects of Resveratrol Supplementation on Methotrexate Chemotherapy-Induced Bone Loss. Nutrients 2017; 9: 255. doi: 10.3390/nu9030255.
58. Lim DBN, Moon RJ, Davies JH. Advances in Diagnosis and Management of Childhood Osteoporosis. J Clin Res Pediatr Endocrinol 2022; 14: 370–384. doi: 10.4274/jcrpe.galenos.2022.2022-8-3.
59. Divittorio G, Jackson KL, Chindalore VL, et al. Examining the relationship between bone mineral density and fracture risk reduction during pharmacologic treatment of osteoporosis. Pharmacotherapy 2006; 26: 104–114. doi: 10.1592/phco.2006.26.1.104.
60. Günay A, Turan S. Pediatric osteoporosis: An update. Trends Pediatr 2024; 5: 105–115. doi: 10.59213/TP.2024.202.

Termedia
About us Contact
Copyright notice Privacy policy Advertising policy Contact us
Quick links
Journals Books eBooks Events
© 2026 Termedia Sp. z o.o.
Developed by Bentus.