University of Oulu

Oskarsson, T, Duun-Henriksen, AK, Bautz, A, et al. Skeletal adverse events in childhood cancer survivors: An Adult Life after Childhood Cancer in Scandinavia cohort study. Int. J. Cancer. 2021; 149( 11): 1863- 1876.

Skeletal adverse events in childhood cancer survivors : an Adult Life after Childhood Cancer in Scandinavia cohort study

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Author: Oskarsson, Trausti1,2; Duun-Henriksen, Anne Katrine3; Bautz, Andrea3;
Organizations: 1Department of Paediatric Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
2Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
3Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
4Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
5Clinical Epidemiology Division, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
6Department of Epidemiology and Public Health, University College London, London, UK
7Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
8Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
9Finnish Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
10Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
11Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
12The Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
13Faculty of Medicine, University of Iceland, Reykjavik, Iceland
14Division of Paediatric Oncology and Haematology, Skåne University Hospital, Lund, Sweden
15Department of Clinical Sciences, Lund University, Lund, Sweden
16Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
17Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.4 MB)
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Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-11-12


The dynamic growth of the skeleton during childhood and adolescence renders it vulnerable to adverse effects of cancer treatment. The lifetime risk and patterns of skeletal morbidity have not been described in a population-based cohort of childhood cancer survivors. A cohort of 26 334 1-year cancer survivors diagnosed before 20 years of age was identified from the national cancer registries of Denmark, Finland, Iceland and Sweden as well as a cohort of 127 531 age- and sex-matched comparison subjects randomly selected from the national population registries in each country. The two cohorts were linked with data from the national hospital registries and the observed numbers of first-time hospital admissions for adverse skeletal outcomes among childhood cancer survivors were compared to the expected numbers derived from the comparison cohort. In total, 1987 childhood cancer survivors had at least one hospital admission with a skeletal adverse event as discharge diagnosis, yielding a rate ratio (RR) of 1.35 (95% confidence interval, 1.29-1.42). Among the survivors, we observed an increased risk for osteonecrosis with a RR of 25.9 (15.0-44.5), osteoporosis, RR 4.53 (3.28-6.27), fractures, RR 1.27 (1.20-1.34), osteochondropathies, RR 1.57 (1.28-1.92) and osteoarthrosis, RR 1.48 (1.28-1.72). The hospitalization risk for any skeletal adverse event was higher among survivors up to the age of 60 years, but the lifetime pattern was different for each type of skeletal adverse event. Understanding the different lifetime patterns and identification of high-risk groups is crucial for developing strategies to optimize skeletal health in childhood cancer survivors.

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Series: International journal of cancer
ISSN: 0020-7136
ISSN-E: 1097-0215
ISSN-L: 0020-7136
Volume: 149
Issue: 11
Pages: 1863 - 1876
DOI: 10.1002/ijc.33741
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3123 Gynaecology and paediatrics
Funding: This project was supported by a grant from the Swedish Childhood Cancer Foundation, Barncancerfonden (PR2011-0047). The funding sources had no involvement in the content or preparation of the article.
Copyright information: © 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.