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http://dx.doi.org/10.3857/jkstro.2009.27.1.15

Analysis of Bone Mineral Density and Related Factors after Pelvic Radiotherapy in Patients with Cervical Cancer  

Yi, Sun-Shin (Department of Family Medicine, Kosin University College of Medicine)
Jeung, Tae-Sig (Department of Radiation Oncology, Kosin University College of Medicine)
Publication Information
Radiation Oncology Journal / v.27, no.1, 2009 , pp. 15-22 More about this Journal
Abstract
Purpose: This study was designed to evaluate the effects on bone mineral density (BMD) and related factors according to the distance from the radiation field at different sites. This study was conducted on patients with uterine cervical cancer who received pelvic radiotherapy. Materials and Methods: We selected 96 patients with cervical cancer who underwent determination of BMD from November 2002 to December 2006 after pelvic radiotherapy at Kosin University Gospel Hospital. The T-score and Z-score for the first lumbar spine (L1), fourth lumbar spine (L4) and femur neck (F) were analyzed to determine the difference in BMD among the sites by the use of ANOVA and the post-hoc test. The study subjects were evaluated for age, body weight, body mass index (BMI), post-radiotherapy follow-up duration, intracavitary radiotherapy (ICR) and hormonal replacement therapy (HRT). Association between the characteristics of the study subjects and T-score for each site was evaluated by the use of Pearson's correlation and multiple regression analysis. Results: The average T-score for all ages was -1.94 for the L1, -0.42 for the L4 and -0.53 for the F. The average Z-score for all ages was -1.11 for the L1, -0.40 for the L4 and -0.48 for the F. The T-score and Z-score for the L4 and F were significantly different from the scores for the L1 (p<0.05). There was no significant difference between the L4 and F. Results for patients younger than 60 years were the same as for all ages. Age and ICR were negatively correlated and body weight and HRT were positively correlated with the T-score for all sites (p<0.05). BMI was positively correlated with the T-score for the L4 and F (p<0.05). Based on the use of multiple regression analysis, age was negatively associated with the T-score for the L1 and F and was positively correlated for the L4 (p<0.05). Body weight was positively associated with the T-score for all sites (p<0.05). ICR was negatively associated with the T-score for the L1 (p<0.05). HRT was positively associated with the T-score for the L4 and F (p<0.05). Conclusion: The T-score and Z-score for the L4 and F were significantly higher than the scores for the L1, a finding in contrast to some previous studies on normal women. It was thought that radiation could partly influence BMD because of a higher T-score and Z-score for sites around the radiotherapy field. We suggest that a further long-term study is necessary to determine the clinical significance of these findings, which will influence the diagnosis of osteoporosis based on BMD in patients with cervical cancer who have received radiotherapy.
Keywords
Radiotherapy; Bone mineral density (BMD); T-score; Uterine cervical cancer;
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1 Consensus Development Conference. Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993;94:646-650   DOI   PUBMED   ScienceOn
2 Khan FM. The physics of radiation therapy. 3rd ed. Philadelphia; Lippincott Williams and Wilkins, 2003:199-201
3 Chen HH, Lee BF, Guo HR, Su WR, Chiu NT. Changes in bone mineral density of lumbar spine after pelvic radiotherapy. Radiother Oncol 2002;62:239-242   DOI   ScienceOn
4 Koh JM. Examples of osteoporosis diagnosis. J Korean Soc Osteoporos 2005;3(suppl 2):49-54
5 Youn SM, Choi TJ, Koo ES, Kim OB, Lee SM, Suh SJ. Effect of pelvic irradiation on the bone mineral content of lumbar spine in cervical cancer. J Korean Soc Ther Radiol Oncol 1997;15:145-152
6 Mitchell MJ, Logan PM. Radiation-induced changes in bone. Radiographics 1998;18:1125-1136   DOI   PUBMED
7 Nguyen T, Sambrook P, Kelly P, et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ 1993;307:1111-1115   DOI   ScienceOn
8 Gillette-Guyonnet S, Nourhashemi F, Lauque S, Grandjean H, Vellas B. Body composition and osteoporosis in elderly women. Gerontology 2000;46:189-193   DOI   ScienceOn
9 Han KO. Basic physiology of bone in understanding osteoporosis. J Korean Soc Osteoporos 2005;3(suppl 2):3-7
10 Stutz JA, Barry BP, Maslanka W, Sokal M, Green DJ, Pearson D. Bone density: is it affected by orchidectomy and radiotherapy given for stage I seminoma of the testis? Clin Oncol 1998;10:44-49   DOI   ScienceOn
11 Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the women's health initiative randomized trial. JAMA 2003;290:1729-1738   DOI   ScienceOn
12 Sahota O, Pearson D, Cawte SW, San P, Hosking DJ. Site-specific variation in the classification of osteoporosis and the diagnostic reclassification using the lowest individual lumbar vertebra T-score compared with the L1-L4 mean in early postmenopausal women. Osteoporos Int 2000;11:852-857   DOI   ScienceOn
13 Yang SO. Importance and proper evaluation of osteoporotic fracture. J Korean Soc Osteoporos 2005;3(suppl 2):17-30
14 Tromp AM, Ooms ME, Popp-Snijders C, Roos JC, Lips P. Predictors of fractures in elderly women. Osteoporos Int 2000;11:134-140   DOI   ScienceOn
15 Park JY. Exercise prescription for the prevention and treatment of osteoporosis. J Korean Med Assoc 2005;48:847-856   DOI
16 Hopewell JW. Radiation-therapy effects on bone density. Med Pediatr Oncol 2003;41:208-211   DOI   PUBMED   ScienceOn
17 Williams HJ, Davies AM. The effect of X-rays on bone. Eur Radiol 2006;16:619-633   DOI   ScienceOn
18 Ryan PJ, Blake GM, Herd R, Parker J, Fogelman I. Distribution of bone mineral density in the lumbar spine in health and osteoporosis. Osteoporos Int 1994;4:67-71   DOI   ScienceOn
19 Hamada K, Hon R, Shigekawa K, et al. The early changes in bone mineral metabolism due to radiation-measurement of bone mineral density in lumbar vertebra by quantitative computed tomography. Nippon Sanka Fujinka Gakkai Zasshi 1991;43:1-7   PUBMED
20 Kanis JA, Gluer CC. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 2000;11:192-202   DOI   ScienceOn
21 Nyaruba MM, Yamamoto I, Kimura H, Morita R. Bone fragility induced by X-ray irradiation in relation to cortical bone mineral content. Acta Radiol 1998;39:43-46   DOI   PUBMED
22 Yu W, Glüer CC, Fuerst T, et al. Influence of degenerative joint disease on spinal bone mineral measurements in postmenopausal women. Calcif Tissue Int 1995;57:169-174   DOI   ScienceOn
23 Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254-1259   DOI   PUBMED   ScienceOn
24 Chang JS. Senile musculoskeletal disorder. J Korean Med Assoc 2005;48:247-253   DOI   ScienceOn
25 Reinbold WD, Wannenmacher M, Hodapp N, Adler CP. Osteodensitometry of vertebral metastases after radiotherapy using quantitative computed tomography. Skeletal Radiol 1989;18:517-521   DOI   ScienceOn
26 NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis and Therapy. Osteoporosis Prevention, Diagnosis and Therapy. JAMA 2001;285:785-795   DOI   PUBMED   ScienceOn
27 Leib ES, Lewiecki EM, Binkley N, Hamdy RC. Official positions of the International society for clinical densitometry. J Clin Densitom 2004;7:1-6   DOI   ScienceOn