Available online 12 January 2024

More than 50% of young pediatric cancer survivors present muscle strength deficits.

Such deficits are associated with lower areal bone mineral density (aBMD) Z-scores at total body (less head), total hip, femoral neck, and lumbar spine.

Each 1-decile lower in muscle strength was associated with 30%–95% higher odds of having low aBMD at most sites.

Early detection of muscle strength deficits after pediatric cancer treatment could help survivors, who lack cancer-related treatment exposures to trigger surveillance, to be screened for low aBMD.

Pediatric cancer survivors are at increased risk of muscle weakness and low areal bone mineral density (aBMD). However, the prevalence of muscle strength deficits is not well documented, and the associations of muscle strength with aBMD are unknown in this population. Therefore, this study aimed to investigate the prevalence of upper- and lower-body muscle strength deficits and to examine the associations of upper- and lower-body muscle strength with age-, sex- and race-specific aBMD Z-scores at the total body, total hip, femoral neck, and lumbar spine.

This cross-sectional study included 116 pediatric cancer survivors (12.1 ± 3.3 years old; 42% female). Upper- and lower-body muscle strength were assessed by handgrip and standing long jump test, respectively. Dual‑energy X‑ray absorptiometry was used to measure aBMD (g/cm2). Associations between muscle strength and aBMD were evaluated in multivariable linear regression models. Logistic regression was used to evaluate the contribution of muscle strength (1-decile lower) to the odds of having low aBMD (Z-score less than –1.0). All analyses were adjusted for time from treatment completion, radiotherapy exposure, and body mass index.

More than one-half of survivors were within the 2 lowest deciles for upper- (56.9%) and lower- (60.0%) body muscle strength in comparison to age- and sex-specific reference values. Muscle strength deficits were associated with lower aBMD Z-scores at all sites (B = 0.133–0.258, p = 0.001–0.032). Each 1-decile lower in upper-body muscle strength was associated with 30%–95% higher odds of having low aBMD Z-scores at all sites. Each 1-decile lower in lower-body muscle strength was associated with 35%–70% higher odds of having low aBMD Z-scores at total body, total hip, and femoral neck.

Muscle strength deficits are prevalent in young pediatric cancer survivors, and such deficits are associated with lower aBMD Z-scores at all sites. These results suggest that interventions designed to improve muscle strength in this vulnerable population may have the added benefit of improving aBMD.

Bone health

Childhood cancer

DXA

Lean mass

Resistance training

© 2024 Published by Elsevier B.V. on behalf of Shanghai University of Sport.