{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T14:54:34Z","timestamp":1791125674081,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2005,11,29]],"date-time":"2005-11-29T00:00:00Z","timestamp":1133222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2007,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Skeletal complications during or after treatment of acute lymphoblastic leukemia (ALL) have been frequently reported and can cause substantial morbidity, yet their incidence is not well established. The present study assessed the incidence of fractures, osteonecrosis (ON), and bone pain during ALL treatment and compared the fracture incidence with age\u2010 and sex\u2010specific reference data from the UK General Practice Research Database (GPRD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>Medical records of 122 ALL patients diagnosed at our institution from 1992 to 2004 were reviewed for information on fractures, ON, bone pain, and their anatomical location, risk group, phase of antileukemic therapy, and time since diagnosis. Evaluation of skeletal complications was followed up until July 2005 or the patient's death. Thirteen children were excluded as they were transferred to other institutions shortly after diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Skeletal complications occurred at a 5\u2010year incidence of 32.7%. The 5\u2010year incidence of fractures, ON, and isolated bone pain was 13.5%, 12.1%, and 12.3%, respectively. The relative rate of fractures adjusted for age and sex was 2.03 (95% confidence interval 1.15\u20133.57) compared to the GPRD, with greatest rates in children &lt;5 years. Thirty ON occurred in 10 patients with a 15 times greater incidence in children &gt;10 years than in those &lt;5 years. Nearly all skeletal complications occurred during maintenance therapy at a median of 14.92 months (range 0.0\u201353.8) after diagnosis and in weight\u2010bearing bones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The doubled fracture rate and the high incidence of skeletal complications during the first years after diagnosis suggest the developing skeleton is very vulnerable in this period. Adolescents develop more ON whereas younger children may be more prone to fractures. Serious \u201cimmediate effects\u201d of chemotherapy on bone appear of great concern and should entail preventative studies in this group of patients. Pediatr Blood Cancer 2007;48:21\u201327. \u00a9 2005 Wiley\u2010Liss, Inc.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.20701","type":"journal-article","created":{"date-parts":[[2005,11,29]],"date-time":"2005-11-29T18:00:05Z","timestamp":1133287205000},"page":"21-27","source":"Crossref","is-referenced-by-count":85,"title":["Incidence of skeletal complications during treatment of childhood acute lymphoblastic leukemia: Comparison of fracture risk with the General Practice Research Database"],"prefix":"10.1002","volume":"48","author":[{"given":"Wolfgang","family":"H\u00f6gler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6tz","family":"Wehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjeerd","family":"van Staa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Meister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Klein\u2010Franke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Kropshofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2005,11,29]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2005.02263.x"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.18.3262"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.12.3066"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20244"},{"key":"e_1_2_6_6_2","first-page":"747","article-title":"Osteonecrosis: An emerging complication of intensive chemotherapy for childhood acute lymphoblastic leukemia","volume":"88","author":"Arico M","year":"2003","journal-title":"Haematologica"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-911X(199901)32:1<11::AID-MPO4>3.0.CO;2-F"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.040902"},{"key":"e_1_2_6_9_2","first-page":"S121","article-title":"Evolution of BFM trials for childhood ALL","volume":"83","author":"Schrappe M","year":"2004","journal-title":"Ann Hematol"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1704835"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.11.2970"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2002.125728"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650111122"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198668040-00003"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.1999.14.12.2010"},{"key":"e_1_2_6_16_2","first-page":"343","article-title":"Bone mineral density in long\u2010term survivors of childhood cancer","volume":"16","author":"Arikoski P","year":"2003","journal-title":"J Pediatr Endocrinol Metab"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2003.18.5.913"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2000.15.6.993"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.2950230608"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.1999.14.9.1473"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-199904010-00014"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2002.17.6.1073"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/1096-911X(20001001)35:4<415::AID-MPO4>3.0.CO;2-9"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.113102"},{"key":"e_1_2_6_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(1998)78:11 <81::AID-IJC23>3.0.CO;2-0"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(1998)78:11 <40::AID-IJC12>3.0.CO;2-H"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2000.15.10.2011"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.116297"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2004.09.008"}],"container-title":["Pediatric Blood &amp; 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