Table 13. Bone and Joint Late Effects
| Predisposing Therapy | Musculoskeletal Effects | Health Screening |
| CT = computed tomography; DXA = dual-energy x-ray absorptiometry; GVHD = graft-versus-host disease; HSCT = hematopoietic stem cell transplantation. | ||
| Radiation impacting musculoskeletal system | Hypoplasia; fibrosis; reduced/uneven growth (scoliosis, kyphosis); limb length discrepancy | Exam: bones and soft tissues in radiation fields |
| Radiation impacting head and neck | Craniofacial abnormalities | History: psychosocial assessment, with attention to: educational and/or vocational progress, depression, anxiety, post-traumatic stress, social withdrawal |
| Head and neck exam | ||
| Radiation impacting musculoskeletal system | Radiation-induced fracture | Exam of affected bone |
| Methotrexate; corticosteroids (dexamethasone, prednisone); radiation impacting skeletal structures; HSCT | Reduced bone mineral density | Bone mineral density test (DXA or quantitative CT) |
| Corticosteroids (dexamethasone, prednisone) | Osteonecrosis | History: joint pain, swelling, immobility, limited range of motion |
| Musculoskeletal exam | ||
| Radiation with impact to oral cavity | Osteoradionecrosis | History/oral exam: impaired or delayed healing following dental work, persistent jaw pain or swelling, trismus |
| HSCT with any history of chronic GVHD | Joint contracture | Musculoskeletal exam |
| Amputation | Amputation-related complications (impaired cosmesis, functional/activity limitations, residual limb integrity, chronic pain, increased energy expenditure) | History: pain, functional/activity limitations |
| Exam: residual limb integrity | ||
| Prosthetic evaluation | ||
| Limb-sparing surgery | Limb-sparing surgical complications (functional/activity limitations, fibrosis, contractures, chronic infection, chronic pain, limb length discrepancy, increased energy expenditure, prosthetic malfunction [loosening, non-union, fracture]) | History: pain, functional/activity limitations |
| Exam: residual limb integrity | ||
| Radiograph of affected limb | ||
| Orthopedic evaluation | ||
