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Are Childhood-Onset Craniopharyngioma Patients at Risk for Low Bone Mass? Insights into Adiposity, Hypogonadism and Growth Hormone

Adriana A. Siviero-Miachon*, Patricia D. Cavalcanti Tosta-Hernandez, Nasjla Saba da Silva, Andrea Cappellano, Marcelo de Medeiros Pinheiro, Angela M. Spinola-Castro

Background: Bone mass may be compromised in childhood-onset craniopharyngioma patients due to different factors. The aim of this study was to evaluate the effect of adiposity, hypogonadism and growth hormone on bone mass in craniopharyngioma patients.

Methods: A cross-sectional study of 46 patients, aged between 6.6 and 32.1 years, 7.5 years from diagnosis, 63% male, 39.1% underwent surgery followed by cranial radiotherapy, assessed according to body fat, lumbar spine and total body bone mineral density through dual energy X-ray absorptiometry, computed tomography scan-derived abdominal adipose tissue, and adipokines by univariate and multivariate regression analyses.

Results: Craniopharyngioma patients presented with decreased lumbar spine and total body bone mass related to therapy (cranial radiotherapy and combinations), but no fractures so far. The body mass index Z score at assessment had a positive mechanical effect on total body bone mass. The replacement of sex steroids at or above 3 years increased bone mass at the total body site. The presence of diabetes insipidus and initiating growth hormone at or above 11.8 years of age had a negative impact on lumbar spine bone mass. Regarding cutoffs, 21.7% of patients presented with decreased lumbar spine bone mass and 10.9% at the total body site, but no differences were observed in spite of growth hormone, sex steroid or sex.

Conclusion: Hypothalamic obesity, therapy, and hormone deficiencies may determine bone mass among craniopharyngioma patients. All these factors might be monitored during follow-up, as they could possibly explain linking mechanisms between bone, metabolism and cancer.