Bone Mineral Density After Contemporary Treatment for Acute Lymphoblastic Leukaemia: A Matched Cross‐Sectional Study

BACKGROUND: Reduced bone mineral density (BMD) has been reported in survivors of childhood and young adult acute lymphoblastic leukaemia (ALL); however, data from cohorts treated with contemporary protocols and including matched controls remain limited. PROCEDURE: In this population-based matched cross-sectional study, we used data from the Danish ALL-STAR cohort, comprising ALL survivors diagnosed between 2008 and 2019 at 1-45 years of age and treated according to the NOPHO ALL2008 protocol, and age- and sex-frequency matched controls. Participants were evaluated at least 1 year after completion of therapy and underwent dual-energy x-ray absorptiometry between 2019 and 2024. BMD was adjusted for sex, age and height and compared with that of matched controls. RESULTS: The study included 298 ALL survivors and 346 matched controls. Median age at follow-up was 14.1 years, and the median time since diagnosis was 6.9 years. The greatest deficits in adjusted BMD were observed at hip sites, particularly among high-risk-treated survivors, with adjusted mean values of 91.2% (95% CI 88.2-94.4) at the femoral neck, 90.1% (95% CI 86.9-93.3) at the total hip, and 90.3% (95% CI 87.0-93.7) at the trochanter. Increasing time since diagnosis was associated with partial normalisation of BMD relative to controls in the standard- and intermediate-risk groups, a pattern not observed among high-risk-treated survivors. CONCLUSIONS: Persistent BMD deficits among survivors treated with high-risk regimens, without evidence of the partial normalisation observed in the standard- and intermediate-risk groups, underscore the need for long-term monitoring of skeletal health in this subgroup.