Oncology therapies (steroids, methotrexate) and supportive care medications (proton pump inhibitors?) are part of a multi-modal approach to curing pediatric acute lymphoblastic leukemia and also contribute to osteopenia/osteoporosis. Pediatric patients are different from adult patients in the way that their bones are still maturing during oncology treatment.
What are the rates of osteopenia/osteoporosis and/or AVN in pediatric leukemia patients (specifically acute lymphoblastic leukemia) who either had sufficient levels of vitamin D prior to therapy or who were administered a vitamin D supplement during therapy? Are there biomarkers that could be obtained to better assess bone health prior to treatment (other than vitamin D levels)? What is the optimal vitamin D level for a pediatric patient undergoing ALL treatment?