Bone mineral density and vertebral fractures in teenage and young adult patients with acute lymphoblastic leukaemia and lymphoblastic lymphoma: A report from the British <scp>OsteoNecrosis</scp> Study ( <scp>BONES</scp> )

The British Osteonecrosis Study (BONES) is the first multicentre prospective study assessing bone health and vertebral fractures in patients aged 10-24 in the United Kingdom undergoing treatment for acute lymphoblastic leukaemia (ALL) or lymphoblastic lymphoma (LBL). Sixty-one patients were recruited from three tertiary centres in the United Kingdom. Dual-energy X-ray absorptiometry (DXA) scans with vertebral fracture analysis were performed within 4 weeks of diagnosis and annually for 3 years. Subjective pain assessments were performed at the same time points. Bone mineral density (assessing total body less head (TBLH)) significantly reduced after 2 years, compared to baseline (estimate = -0.964, 95% CI [-1.357, -0.572]), with the greatest decrease occurring within the first year. Vertebral fracture prevalence was 4.9%, with two further patients experiencing incident vertebral fractures. All vertebral fractures occurred in male patients, 75% of whom were British Asian. Back pain was not a predictor of low bone mineral density (BMD) or vertebral fractures. We report a lower vertebral fracture prevalence in patients aged 10-24 with ALL than has been previously reported in a cohort of younger patients. Male British Asian patients appeared to be at higher risk of vertebral fractures in our study. BMD and pain were not predictors of vertebral fractures.