Bone Health Issues in the Pediatric Oncology Patient.

OBJECTIVE: This article reviews how childhood cancers and related treatments affect bone integrity. Interventions related to exercise, hormone replacement, vitamin D and calcium supplementation, and bisphosphonate use are addressed. DATA SOURCES: Literature was reviewed related to childhood cancers, treatment and side effects, assessment, and management to optimize bone health.
CONCLUSIONS: Cure rates of childhood cancer have dramatically improved due to new therapeutic advances allowing children diagnosed with cancer to live longer. Unfortunately, the cost of cure can be the increased development of chronic health issues. Since many children receive their treatment, including antineoplastic agents, radiation, surgery, and corticosteroid therapy, during time of active skeletal maturation and growth, their bone health may be negatively impacted. The development of bone mass can be impaired, bone density may be decreased, fractures may occur, growth may be restricted, and there may be poor bone repair. Review of the data indicates that more research is needed to understand what is necessary for optimal bone health in the pediatric population in general, specifically for the child affected by cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses are integral to the development of comprehensive understanding of the bone health needs of the pediatric oncology patient population and educating the patient and family about the importance of bone health. Children and young adult survivors would benefit from collaborative care between all their health care providers. Steps to improve bone health before diagnosis, on treatment, and through to survivorship remain to be addressed by future research.