{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:15:54Z","timestamp":1791490554390,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006244","name":"Stichting Kinderen Kankervrij","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006244","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Wilms tumors (WT) are the most common kidney tumors in children, with excellent survival rates (90%). However, late adverse effects warrant attention. Limited data exist on musculoskeletal sequelae in WT survivors. We aimed to assess the prevalence and determinants of impaired bone mineral density (BMD) and fractures in a national cohort of Dutch WT survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      This cross\u2010sectional study includes WT survivors treated between 1963 and 2002, recruited as part of the DCCSS\u2010LATER cohort between 2016 and 2020. Dual\u2010energy X\u2010ray absorptiometry (DXA) scans were used to assess BMD. Low BMD was defined as a\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010score \u2264\u20091. From 5\u2009years after diagnosis, fracture prevalence was assessed by questionnaires. Univariable logistic regression was used to analyze associations between impaired BMD as well as fractures with independent variables like patient characteristics, treatments, comorbidities, and lifestyle\u2010related factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 437 invited kidney tumor survivors, 233 WT survivors participated (median age 32.1\u2009years, median follow\u2010up 27.8\u2009years). DXA scans and fracture data were available for 173 and 221 WT survivors, respectively. Low BMD at any site was observed in 26% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200946\/173) of survivors and was significantly associated with treatment including \u2265\u20094 drugs (OR 2.76; 95% CI\u2009=\u20091.13\u20136.70). Abdominal radiotherapy doses &gt;\u200930\u2009Gy (OR 4.84; 95% CI\u2009=\u20091.06\u201322.2) were significantly associated with low lumbar spine BMD. The prevalence of fragility fractures was 16.3% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936\/221). The standardized incidence ratio (SIR) of any first fracture was 2.34 for males and 5.38 for females.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Wilms tumor survivors treated with \u2265\u20094 drugs or abdominal radiotherapy (&gt;\u200930\u2009Gy) seem to be at increased risk of impaired BMD; this could indicate the need for surveillance for this subset of Wilms tumor survivors exposed to these treatment regimens in the past.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71229","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T09:29:03Z","timestamp":1758014943000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and Determinants of Impaired Bone Mineral Density and Fractures in the First National Dutch Wilms Tumor Survivor Cohort, a National\n                    <scp>DCCSS<\/scp>\n                    \u2010\n                    <scp>LATER<\/scp>\n                    Study"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1976-9962","authenticated-orcid":false,"given":"Francis S. P. L.","family":"Wens","sequence":"first","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demi T. C.","family":"de Winter","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert O.","family":"Janssens","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"},{"name":"University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rens","family":"Litjens","sequence":"additional","affiliation":[{"name":"University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4436-0089","authenticated-orcid":false,"given":"Jenneke E.","family":"van Atteveld","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutger A. J.","family":"Nievelstein","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"},{"name":"University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique G. G.","family":"Hobbelink","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrica C. H.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"},{"name":"Sophia Children's Hospital\/Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline J.","family":"Loonen","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline","family":"van Dulmen\u2010den Broeder","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Center  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena J. H.","family":"van der Pal","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia M. F.","family":"Pluijm","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leontien C. M.","family":"Kremer","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"},{"name":"Emma Children's Hospital\/Amsterdam UMC  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margriet","family":"van der Heiden\u2010van der Loo","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marloes","family":"Louwerens","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke M.","family":"van Santen","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology  Utrecht the Netherlands"},{"name":"Division of Childhealth, Wilhelmina Children's Hospital University Medical Center  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Olsson","sequence":"additional","affiliation":[{"name":"Institute of Medicine University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imo","family":"Hoefer","sequence":"additional","affiliation":[{"name":"University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoerd A. 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