Bone mineral density in patients with thalassemia major, the experience of a single institute

Abstract

Thalassemia is an inherited disorder causing an imbalance in the development of the globin chain with ineffective erythropoiesis and increased peripheral consumption. Expansion of bone marrow decreases bone mineral density. Bone disease in thalassemia is manifested as diffuse bone pain, scoliosis, spinal deformities, nerve compression, spontaneous fracture. Bone Mineral Density (BMD) is a useful indicator for bone monitoring and assessment and significant predictor of bone disease in thalassemia. The purpose of this study is to evaluate Bone Mineral Density in thalassemia patients and its correlation with other factors. The study was conducted in Hematology Center at Al-Karama Teaching Hospital, Wasit, Iraq, from the first of January to the thirty of April 2019. Fifty-eight thalassemia patients were enrolled in this study. Bone mineral density was assessed using Dual-Energy X-ray Absorptiometry technique (DEXA scan) for the lumber spine (L1-L4) at the Dexa unit in the rehabilitation Center in KUT. The patients were divided according to BMD by Z-Score ≤ 15 years old patients, T score for adults (>15 years old) into three groups: a score ≥ -1 defined as Normal BMD, Osteopenia (between -1 and -2.5 SD), and  Osteoporosis (below -2.5 SD). The effect of Gender, Age, frequency of blood transfusion, Hb level, Serum Calcium, and Serum Ferritin on BMD was evaluated. Young patients (with age equal to or younger than 15 years) showed lower bone density than older patients. Also, Patients with Suboptimal blood transfusion had lower bone density than patients than good compliance blood transfusion program, P-value 0.001, 0.012, respectively. The results indicated a direct relationship between the age of the thalassemia patients and bone mass density, P-value = 0.0001, Pearson Correlation = 0.7. Low bone density was reported in young age and suboptimal blood transfusion.