Osteonecrosis and Low Bone Mineral Density in a Pediatric Patient with Acute Lymphoblastic Leukemia (ALL)

Patient selection: acute lymphoblastic leukemia (ALL)

Risk factors:

(1) older age at diagnosis (>= 10 years)

(2) more intensive chemotherapy regimens (for standard and high-risk ALL)

Bone mineral density (BMD) was considered to be profoundly low if the Z-score was <= -2.0 (measured at first and second lumbar vertebrae).

Osteonecrosis is graded by whether it is < 30% or >= 30% of epiphyseal involvement.

Sites most often affected by osteonecrosis:

(1) knee

(2) hip

Osteonecrosis was associated with profoundly low bone mineral density Z-scores.