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In the present study we investigated bone mineralization density distribution by quantitative back-scattered electron imaging (qBEI) and bone histomorphometry by light microscopy in pediatric ALL patients at diagnosis, before any cancer treatment. In our one-center LELU study, we obtained bone marrow biopsies from the posterior iliac crest in 11 boys and 15 girls (median age 4.3; range 2.6\u201315.8\u00a0years) in connection with ALL diagnostic sampling. Blood samples were drawn for biochemistry and BMD was measured by DXA. Despite normal DXA-derived BMD, qBEI revealed undermineralization of bone matrix in our ALL-patient cohort. The average degree of mineralization was reduced (\u2212\u20098%) and the proportion of lowly mineralized bone area was increased compared to pediatric reference values (+\u2009152%, both\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Bone histomorphometry revealed normal osteoid thickness, but markedly reduced osteoblast and eroded surface. Bone marrow fibrosis was observed in 24\/26 samples. Neither BMD nor serum 25-OH-vitamin D correlated with bone matrix mineralization or histomorphometric parameters. In conclusion, our study showed a marked hypomineralization of the bone matrix in children at ALL diagnosis, prior to cancer treatment. These data suggest an early and significant impact of the ALL-disease process on bone homeostasis and material quality.\n                  <\/jats:p>","DOI":"10.1007\/s00223-026-01509-7","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T08:28:07Z","timestamp":1775118487000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low Bone Turnover and Decreased Bone Matrix Mineralization at Diagnosis in Children with Acute Lymphoblastic Leukemia"],"prefix":"10.1007","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9148-9291","authenticated-orcid":false,"given":"Pauliina","family":"Utriainen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6046-0365","authenticated-orcid":false,"given":"Markus A.","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6575-8443","authenticated-orcid":false,"given":"St\u00e9phane","family":"Blouin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9949-7474","authenticated-orcid":false,"given":"Takolander","family":"Sofia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4547-001X","authenticated-orcid":false,"given":"Outi","family":"M\u00e4kitie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1164-1877","authenticated-orcid":false,"given":"Nadja","family":"Fratzl-Zelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"1509_CR1","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1038\/leu.2017.265","volume":"32","author":"N Toft","year":"2018","unstructured":"Toft N, Birgens H, Abrahamsson J, Gri\u0161kevi\u010dius L, Hallb\u00f6\u00f6k H, Heyman M et al (2018) Results of NOPHO ALL2008 treatment for patients aged 1\u201345 years with acute lymphoblastic leukemia. 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