@article{MuellerWinterRosenbaumetal.2010,
  author    = {M{\"u}ller, Carsten and Winter, Corinna and Rosenbaum, Dieter and Boos, Joachim and Gosheger, Georg and Hardes, Jendrik and Vieth, Volker},
  title     = {Early decrements in bone density after completion of neoadjuvant chemotherapy in pediatric bone sarcoma patients},
  series = {BMC Musculoskeletal Disorders},
  volume    = {11},
  journal   = {BMC Musculoskeletal Disorders},
  number    = {287},
  doi       = {10.25974/fhms-16866},
  url       = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-168661},
  pages     = {1 -- 8},
  year      = {2010},
  abstract  = {Background Bone mineral density (BMD) accrual during childhood and adolescence is important for attaining peak bone mass. BMD decrements have been reported in survivors of childhood bone sarcomas. However, little is known about the onset and development of bone loss during cancer treatment. The objective of this cross-sectional study was to evaluate BMD in newly diagnosed Ewing's and osteosarcoma patients by means of dual-energy x-ray absorptiometry (DXA) after completion of neoadjuvant chemotherapy. Methods DXA measurements of the lumbar spine (L2-4), both femora and calcanei were performed perioperatively in 46 children and adolescents (mean age: 14.3 years, range: 8.6-21.5 years). Mean Z-scores, areal BMD (g/cm2), calculated volumetric BMD (g/cm3) and bone mineral content (BMC, g) were determined. Results Lumbar spine mean Z-score was -0.14 (95\% CI: -0.46 to 0.18), areal BMD was 1.016 g/cm2 (95\% CI: 0.950 to 1.082) and volumetric BMD was 0.330 g/cm3 (95\% CI: 0.314 to 0.347) which is comparable to healthy peers. For patients with a lower extremity tumor (n = 36), the difference between the affected and non-affected femoral neck was 12.1\% (95\% CI: -16.3 to -7.9) in areal BMD. The reduction of BMD was more pronounced in the calcaneus with a difference between the affected and contralateral side of 21.7\% (95\% CI: -29.3 to -14.0) for areal BMD. Furthermore, significant correlations for femoral and calcaneal DXA measurements were found with Spearman-rho coefficients ranging from ρ = 0.55 to ρ = 0.80. Conclusions The tumor disease located in the lower extremity in combination with offloading recommendations induced diminished BMD values, indicating local osteopenia conditions. However, the results revealed no significant decrements of lumbar spine BMD in pediatric sarcoma patients after completion of neoadjuvant chemotherapy. Nevertheless, it has to be taken into account that bone tumor patients may experience BMD decrements or secondary osteoporosis in later life. Furthermore, the peripheral assessment of BMD in the calcaneus via DXA is a feasible approach to quantify bone loss in the lower extremity in bone sarcoma patients and may serve as an alternative procedure, when the established assessment of femoral BMD is not practicable due to endoprosthetic replacements.},
  language  = {en}
}
@article{WinterMuellerBrandesetal.2009,
  author    = {Winter, Corinna and M{\"u}ller, Carsten and Brandes, Mirko and Brinkmann, Anja and Hoffmann, Christiane and Hardes, Jendrik and Gosheger, Georg and Boos, Joachim and Rosenbaum, Dieter},
  title     = {Level of activity in children undergoing cancer treatment},
  series = {Pediatric Blood \& Cancer},
  volume    = {53},
  journal   = {Pediatric Blood \& Cancer},
  number    = {3},
  doi       = {10.1002/pbc.22055},
  pages     = {438 -- 443},
  year      = {2009},
  abstract  = {Background The diagnosis of cancer bears severe implications for pediatric patients. One immense restriction consists in a reduced level of activity due to different factors. Physical activity affects various aspects of development and can be regarded as an essential part of a child's life. In the present study physical activity in patients undergoing cancer therapy was quantified in order to determine the extent of the restriction and to provide baseline information for the assessment of possible interventions. Procedure Physical activity in 80 patients and 45 healthy children matched for age and gender was measured using the StepWatch 3™ Activity Monitor (SAM, OrthoCare Innovations). Results Pediatric cancer patients, at 2,787 gait cycles (gcs) per day, were significantly less active than their healthy counterparts (8,096 gcs). Patients were significantly more active at home than during inpatient stays (3,185 gcs compared to 1,830 gcs), and patients with bone tumors were less active than those with leukemia regarding both, the amount (1,849 gcs vs. 2,992 gcs) and the intensity of activity. Conclusion The present study quantified an often observed but so far hardly assessable problem. Activity in cancer patients is considerably reduced and patients with bone tumors are at increased risk from the detrimental effects of prolonged inactivity. Both our findings and the accepted fact that activity is an essential element of child development confirm the need for interventions tailored to a patient's needs and abilities during the course of treatment.},
  language  = {en}
}
@article{MuellerWinterRosenbaumetal.2015,
  author    = {M{\"u}ller, Carsten and Winter, Corinna and Rosenbaum, Dieter and Boos, Joachim and Gosheger, Georg and Hardes, Jendrik and Vieth, Volkier},
  title     = {Sport- und Bewegungstherapie mit Kindern und Jugendlichen w{\"a}hrend der Akuttherapie eines Knochentumors der unteren Extremit{\"a}t. Entwicklung des Aktivit{\"a}tsniveaus und Einfluss auf die Knochendichte},
  series = {P{\"a}diatrische Praxis},
  volume    = {83},
  journal   = {P{\"a}diatrische Praxis},
  number    = {4},
  issn      = {0030-9346},
  pages     = {673 -- 683},
  year      = {2015},
  abstract  = {Tumorerkrankungen im Kindes- und Jugendalter haben w{\"a}hrend der Akuttherapie und dar{\"u}ber hinaus einen signifikanten Einfluss auf das Aktivit{\"a}tsniveau und den Knochenstoffwechsel. Dieser Beitrag untersucht, inwiefern bewegungstherapeutische Interventionen das Aktivit{\"a}tsniveau und damit auch die Entwicklung der Knochendichte w{\"a}hrend der Akuttherapie von Patienten mit Knochentumoren der unteren Extremit{\"a}t beeinflussen k{\"o}nnen. 21 Kinder und Jugendliche im Alter von 13,6 Jahren konnten in die Untersuchung aufgenommen werden und wurden einer Interventions- (IG, n=10) oder einer Kontrollgruppe (KG, n=11) zugeordnet. S{\"a}mtliche Patienten erhielten die standardisierte physiotherapeutische Behandlung. Der IG wurde zus{\"a}tzlich ein Sportprogramm angeboten, das an jedem zweiten Tag w{\"a}hrend der Akuttherapie absolviert werden sollte. Die Knochendichte der Lendenwirbels{\"a}ule und des nicht betroffenen Schenkelhalses wurde mittels Dual-R{\"o}ntgen-Absorptiometrie (DXA) w{\"a}hrend der Lokaltherapie, sowie nach sechs und nach zw{\"o}lf Monaten erfasst. Die Alltagsaktivit{\"a}ten wurden zeitgleich nach sechs und zw{\"o}lf Monaten im heimischen Umfeld objektiv mit einem Beschleunigungsaufnehmer {\"u}ber einen Zeitraum von sieben Tage erhoben. In beiden Patientengruppen wurde w{\"a}hrend der Akuttherapie eine deutliche Reduktion der Knochendichte beobachtet. Im Gruppenvergleich zeigten sich in der Entwicklung der Knochendichte zwischen den Messzeitpunkten kleine bis große Effekte zugunsten der bewegungstherapeutischen Intervention. Zudem weist die Interventionsgruppe im Vergleich zur Kontrollgruppe durchweg signifikant h{\"o}here Alltagsaktivit{\"a}ten (durchschnittliche Schrittzahl pro Tag und Phasen hoher k{\"o}rperlicher Aktivit{\"a}t) auf. Die Ergebnisse belegen die Durchf{\"u}hrbarkeit und den Nutzen eines therapiebegleitenden Sportprogramms f{\"u}r Kinder und Jugendliche w{\"a}hrend der Akutphase der Behandlung einer Knochentumorerkrankung der unteren Extremit{\"a}t.},
  language  = {de}
}
@article{MuellerWinterBoosetal.2014,
  author    = {M{\"u}ller, Carsten and Winter, Corinna and Boos, Joachim and Gosheger, Georg and Hardes, Jendrik and Vieth, Volker and Rosenbaum, Dieter},
  title     = {Effects of an exercise intervention on bone mass in pediatric bone tumor patients},
  series = {International Journal of Sports Medicine},
  volume    = {35},
  journal   = {International Journal of Sports Medicine},
  number    = {08},
  doi       = {10.1055/s-0033-1358475},
  pages     = {696 -- 703},
  year      = {2014},
  abstract  = {The aim was to evaluate the effects of additional exercises during inpatient stays on bone mass in pediatric bone tumor patients. 21 patients were non-randomly allocated either to the exercise group (n=10) or the control group (n=11). DXA of the lumbar spine, the non-affected femur and both calcanei was performed after completion of neoadjuvant chemotherapy (baseline), as well as 6 and 12 months after baseline. Bone mineral content (BMC), bone mineral density (BMD) and height-corrected lumbar spine Z-scores were determined. Group changes after 6 and 12 months were compared by covariance analyses. Additionally, daily physical activities (PA) were assessed by means of accelerometry. After adjusting for initial age, height and weight, mean reductions in lumbar spine and femoral BMC were lower in the exercise group (not significant). Effect sizes during the observational period for lumbar spine and femur BMC were generally small (partial η²=0.03). The exercise group demonstrated substantially higher PA levels in terms of gait cycles per day, per hour and moderate PA (activities above 40 gait cycles per minute). Additional exercises for bone tumor patients are feasible during hospitalization. Though the intervention did not influence BMC, it appeared beneficial regarding PA promotion with respect to volume and intensity.},
  language  = {en}
}
@article{WinterMuellerHardesetal.2011,
  author    = {Winter, Corinna and M{\"u}ller, Carsten and Hardes, Jendrik and Boos, Joachim and Gosheger, Georg and Rosenbaum, Dieter},
  title     = {Pediatric patients with a malignant bone tumor: when does functional assessment make sense?},
  series = {Supportive Care in Cancer},
  volume    = {20},
  journal   = {Supportive Care in Cancer},
  doi       = {10.1007/s00520-010-1077-5},
  pages     = {127 -- 133},
  year      = {2011},
  abstract  = {Purpose The diagnosis of a malignant bone tumor in the lower limb is a risk factor for physical disability, limiting physical performance. Walking ability especially, which is essential for most activities of daily living, is limited in those patients. In the present study, the extent of limitations during the course of treatment was investigated to determine when the assessment of functional parameters is meaningful in those patients. Methods In the present study, activity levels were determined in 20 patients with a malignant bone tumor in the lower limb who received endoprosthetic replacement of the affected bone and in 20 healthy individuals. A uniaxial accelerometer was used to investigate patients at five different time points after surgery. Results Patients performed significantly less amounts and intensities of activity than control individuals at all measurements. Significant increases in the volume of activity were observed after cessation of treatment. However, the intensity of activity only showed minor increases. Patients experiencing complications of surgery revealed greater restriction than those without even 18 months after surgery. Conclusions After cessation of treatment for their disease, patients recovered markedly and showed great improvements in physical activity. However, some limitations appeared to persist. Comparisons with patients with longer follow-up revealed that meaningful functional assessment does not make sense within the first 12 months after surgery. More research is needed to show if longer follow-up periods reveal further improvements. Based on such information, it should be more promising to develop individually tailored activity recommendations and intervention programs.},
  language  = {en}
}