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Lymphoma Chemotherapy Raises Risk for Osteoporosis


 

GLASGOW, SCOTLAND — Chemotherapy for lymphoma should be recognized as a risk factor for the development of osteoporosis, Dr. Bhaskar Dasgupta reported in a poster session at the annual meeting of the British Society for Rheumatology.

Patients with lymphoma have greatly improved survival rates because of advances in treatment, but their quality of life may be compromised by long-term complications of chemotherapy, reported Dr. Dasgupta, director of rheumatology, Southend Hospital NHS Trust, Westcliff on Sea, England. Osteoporosis is one such potential complication that can result from treatment with alkylating agents and the steroids that are often given with chemotherapy.

Height loss as a surrogate marker for vertebral osteoporosis was evaluated in a study of patients attending a lymphoma clinic. A total of 25 patients, 8 with Hodgkin's and 17 with non-Hodgkin's lymphoma, were enrolled. Mean age was 57.6 years, and 13 of the patients were female, reported Dr. Dasgupta.

Exclusion criteria included a previous osteoporosis diagnosis, lymphoma with spinal involvement, and previous corticosteroid treatment.

When baseline height was compared with height 24 months or more after chemotherapy, the mean loss was found to be 22.8 mm, according to Dr. Dasgupta.

The degree of height loss increased with age—every 10-year increase in age was associated with a 5.2-mm decrease in height, he reported. No association was seen between height loss and gender, and none of the patients had other risk factors for osteoporosis, according to questionnaires they had filled out.

Case notes were examined for cumulative steroid dose and the type of chemotherapy received, with no height loss association found. Patients whose height loss exceeded 40 mm were more likely to be symptomatic. Two patients whose height loss was 50 mm or more reported disabling back pain and poor quality of life.

Despite the fact that significant height loss was seen in this group of patients, none had received bisphosphonates or vitamin D, and only one patient was taking a calcium supplement, Dr. Dasgupta noted. Also, none of the patients had had a bone mineral density determination.

“Our findings suggest that larger studies of osteoporosis and its complications following chemo-therapy are needed, and that appropriate investigations and prophylactic management are indicated, especially in the elderly,” Dr. Dasgupta concluded.

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