Survivors of Pediatric HSCT Exhibit Mandibular Bone Impairments

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Study findings have revealed that survivors of pediatric hematologic malignancies who underwent hematopoietic stem-cell transplantation (HSCT) exhibit quantitative and qualitative mandibular bone impairments.

It’s hypothesized that survivors of pediatric hematologic malignancies who underwent hematopoietic stem-cell transplantation (HSCT) may be affected by a wide range of adverse effects later in life, including reduced bone mineral density (BMD) and an increased risk of bone fractures. Using panoramic radiographs, researchers have revealed new findings indicating that these patients exhibit quantitative and qualitative mandibular bone impairments.

The researchers collected 52 digital panoramic radiographic images, which included 21 from childhood HSCT survivors aged 3.69 to 18.88 years and 31 from healthy controls aged 3.69 to 25.1 years. Radiographic images were collected 6.59-83.95 months following bone marrow transplantation between September 2015 and December 2017.

A quantitative analysis of the images showed that the mandibular cortical bone width was 17% smaller among HSCT patients compared with the healthy controls (HSCT patients: 2.420, control group: 3.307).


“HSCT involves corticosteroid administration, which inhibits multiple pathways, including reduced osteoblastic activity, increased osteoclastic bone resorption, and inhibition of vitamin D 1α-hydroxylation with impairment of intestinal calcium absorption and reduced muscle strength,” wrote the researchers. “Additionally, endocrine complications due to chemotherapy and/or radiotherapy, such as growth hormone deficiency and hypogonadism, can adversely affect BMD.”

A qualitative analysis also revealed a higher prevalence of severe cortical erosion among HSCT patients, although the difference between the 2 groups was not statistically significant (HSCT patients: 1.540, control group: 2.605).

Study participants were recruited from the Pediatric Oncology Institute at the University of São Paulo Medical School in São Paulo, Brazil. The primary diagnosis was acute myeloid leukemia (56%), acute lymphoblastic leukemia (38%), and myelodysplastic syndrome (6%). Autogenous HSCT made up 29% of cases, allogenic HSCT made up 58% of cases.

“The qualitative and quantitative assessment of mandibular cortical bone provides predictive information for the early diagnosis of osteoporosis in adults, but few studies have been conducted in children,” explained the researchers, who added that the study findings support previous research indicating that dentists can actively help identify patients at risk of low BMD based on mandibular cortical erosion and refer these patients to further testing.


Franscino A, Costa C, Salgado D, Coracin F, Fava M, Odone-Filho V. Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplanation [published online May 22, 2019]. Clinics. doi: 10.6061/clinics/2019/e929.