{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T19:08:35Z","timestamp":1775156915049,"version":"3.50.1"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013229","name":"C17 Children's Cancer and Blood Disorders","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013229","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["FRN64285"],"award-info":[{"award-number":["FRN64285"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013231","name":"Kids With Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013231","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001256","name":"National Childhood Cancer Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001256","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Bone &amp; Mineral Res"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Osteonecrosis (ON) is a serious complication of childhood acute lymphoblastic leukemia. We determined the prevalence of osteonecrotic lesions in our patient population by a one\u2010time multisite magnetic resonance imaging (MRI) more than 1\u2009year following leukemia therapy. MRI findings were evaluated in relationship to clinical factors (including longitudinal changes in bone mineral density [BMD]). Eighty\u2010six children enrolled in the Steroid Associated Osteoporosis in the Pediatric Population (STOPP) study were evaluated for ON at 3.1\u2009\u00b1\u20091.3\u2009years following therapy. Thirty children had a total of 150 confirmed ON lesions (35%). Lumbar spine (LS) BMD\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores (mean\u2009\u00b1\u2009SD) were low at diagnosis and similar between patients with and without ON (\u22121.09\u2009\u00b1\u20091.53 versus \u22121.27\u2009\u00b1\u20091.25,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.549). LS BMD\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores declined from baseline to 12\u2009months in children with ON (\u22120.31\u2009\u00b1\u20091.02) but not in those without (0.13\u2009\u00b1\u20090.82,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.035); the hip BMD\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores from baseline to 24\u2009months declined in both groups, but to a greater extent in those with ON (\u22121.77\u2009\u00b1\u20091.22) compared to those without (\u22121.03\u2009\u00b1\u20091.07,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.045). At the time of the MRI, mean total hip and total body (TB) BMD\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores were lower in children with ON (hip \u22120.98\u2009\u00b1\u20090.95 versus \u22120.28\u2009\u00b1\u20091.06,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.010; TB \u22121.36\u2009\u00b1\u20091.10 versus \u22120.48\u2009\u00b1\u20091.50,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.018). Pain occurred in 11\/30 (37%) with ON versus 20\/56 (36%) without,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.841. In multivariable models, older age at diagnosis (odds ratio [OR] 1.57; 95% confidence interval [CI], 1.15\u20132.13;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004), and hip BMD\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010score at MRI (OR 2.23; 95% CI, 1.02\u20134.87;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.046) were independently associated with ON. Overall, one\u2010third of children demonstrated ON after leukemia therapy. Those with ON had greater reductions in spine and hip BMD\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores in the first 1 and 2\u2009years of therapy, respectively. Older age and lower hip BMD\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores at MRI were significantly associated with prevalent, off\u2010therapy ON. These data assist in identifying children at risk of ON. \u00a9 2023 The Authors.\n                    <jats:italic>Journal of Bone and Mineral Research<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).\n                  <\/jats:p>","DOI":"10.1002\/jbmr.4870","type":"journal-article","created":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T09:02:06Z","timestamp":1686906126000},"page":"1104-1115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Reductions in Bone Mineral Density Are Apparent Early in Children With Prevalent Osteonecrosis Lesions Following Leukemia Therapy"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4426-8258","authenticated-orcid":false,"given":"Jacqueline M.","family":"Halton","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Ottawa 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