Application of Dual-Energy X-Ray Absorptiometry for Bone Mineral Density Screening in Pediatric, Adolescent, and Young Adult Cancer Survivors: A Multi-Institutional Study of 6 California Children’s Hospitals

Deficits in bone mineral density (BMD) represent a major late effect on survivors of childhood cancer and can lead to increased fracture risks and morbidity that can persist in late adulthood. Low BMD is defined as >2 SDs below the mean of the age- and sex-specific reference population ( Z -score ≤−2). Current guidelines recommend screening for low BMD with dual-energy x-ray absorptiometry (DXA) when at-risk patients enter long-term follow-up. We performed a retrospective chart review to study the application of BMD screening guidelines across 6 California pediatric cancer survivorship programs to assess variations in practice patterns. Our study showed inter-institutional variability in the management of pediatric, adolescent, and young adult cancer survivors with low bone mineral density between 2015 and 2019. We found differences in rates of referral to subspecialists such as endocrinology and orthopedics. There was no significant difference in the distribution of diagnoses of patients who had a DXA scan at each institution. The incidence of complications from low BMD was very rare in the studied population. Further studies on the risks and management of low BMD are necessary to inform evidence-based guidelines that can foster increased harmonization of practice patterns among survivorship groups.