الفهرس 
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Abstract
Leukemias account for about one third of all cancers in children. Acute leukemias constitute 97% of all childhood leukemias, of which 75% are acute lymphoblastic leukemia (ALL).
Bone is a specialized form of metabolically active, mineralized connective tissue. It is a “dynamic tissue” that is remodeled constantly throughout life by a continuous cycle of modeling (resorption followed by formation at a distant skeletal site) and remodeling (resorption followed by formation at the same skeletal site). About 10% of bone is normally replaced each year in children. Thus the growing skeleton is particularly vulnerable to the effects of childhood ALL.
Improvements in diagnostics and therapeutic procedures have led to increased survival rates in childhood malignancies. Approximately two-thirds of all patients are cured and reach adulthood. There is increasing concern over the quality of life in these patients. Skeletal problems are being ever more commonly recognized in children with ALL at diagnosis, during therapy, and after completion of treatment.
Contributing factors for decreased BMD are many. These include the disease itself, systemic or intrathecal treatment with corticosteroids (CS) and methotrexate (MTX), radiotherapy, poor muscle mass, limited physical activity, and nutritional deficiencies such as low calcium intake and hypovitaminosis D.
The present study’s aim was to study bone density and serum Bone specific alkaline phosphatase level in children with acute lymphoblastic leukemia.
This study was carried out on forty five children with acute lymphoblastic leukemia (ALL) attending the hematology oncology unit at Alexandria University Children’s Hospital (AUCH), divided into three groups: fifteen children at diagnosis of ALL and before starting their treatment regimen, fifteen children at start of maintenance phase of treatment and Fifteen children after completing their treatment regimen ”off therapy”. There were 21 males and 24 females, their age ranged from 2.1 to 10 years with a mean of 5.2 years.
All children included in the study were subjected to full history taking including personal data, nutritional history, symptoms of bone involvement, data related to leukemia diagnosis and treatment. Clinical examination was done stressing on signs of bone affection.
Laboratory investigations included complete blood count, serum electrolytes including calcium, phosphorus, magnesium, serum alkaline phosphatase, bone specific alkaline phosphatase. Radiological assessment of bone density by DEXA scan.
The results of CBC and serum electrolytes including calcium, phosphorus and magnesium showed no significant difference between the studied groups.
In the present study, it was found that the most common presenting symptom was fever which was present in 35 (77.8%) children. Followed by bone pain which was present in 26 (57.8%) children. The presence of bone symptoms at time of examination was done in the studied groups and it was found that In group I, 8 (53.3%) children had bone pain at time of examination while in group II, 4 (26.7%) children only had bone pain. In group III