Assessment of bone mineral density in multi-transfused thalassemia patients in a tertiary care hospital
Abstract
Objective: Patients with transfusion-dependent thalassemia (TDT) are susceptible to osteopenia and osteoporosis, the mechanism is multi-factorial. Transfusion-related iron overload in endocrine organs leads to impaired hormonal secretion, all contributing to bone loss. The aim is the assessment of bone loss frequency and related parameters affecting it in TDT patients in tertiary care Centre, Jamnagar.
Design: Observational cross-sectional study.
Subjects: 33.
Methods: The study is conducted over 1 year in TDT patients attending G.G.G. hospital for blood transfusion. After clearance from the ethical committee and consent from parents, patients selected according to inclusion criteria and scanned for Bone Mineral Density (BMD) and biochemical tests. Results analyzed with the help of standard statistical tests.
Results: Out of 33 patients, 36% (12) patients had osteopenia while 45% (15) patients had osteoporosis. 84% (16) of 19 male patients and 78% (11) of 14 female patients had low BMD. 80% (4) of 5 patients with high S.TSH levels and all patients with low calcium levels, were detected with low BMD.11% (3) of 27 patients having low BMD, had high S. Alkaline phosphatase level. 85% (6) of 7 patients with low S.FSH levels and 73% (8) of 11 patients with low S.L.H. levels have low BMD. 87% (14) of 16 patients with short stature have low bone mass.
Conclusion: Evaluating BMD annually in TDT patients helps prevent and intervene timely. Administration of bisphosphonates, calcium, vitamin-D supplements, hormone replacement therapy, bone-forming agents and newer therapies will help improve bone mass. Changing lifestyle with appropriate diet and exercise, iron chelation therapy, early diagnosis and treatment of endocrine insufficiency and regular blood transfusions help achieve optimal bone density.
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References
Verma, I.C. Burden of genetic disorders in india. Indian J Pediatr. 2000;67:893-898. doi: https://doi.org/10.1007/BF02723953.
Patel Ashwin P, Naik Madhuben R, Shah Nilam M, Sharma Narmadeshwar P, Parmar Prakash H. Prevalence of common hemoglobinopathies in gujarat: an analysis of a large population screening program. Nat J Comm Med. 2012;3(1):112-114.
Mahachoklertwattana P, Chuansumrit A, Sirisriro R, Choubtum L, Sriphrapradang A, Rajatanavin R. Bone mineral density, biochemical and hormonal profiles in suboptimally treated children and adolescents with beta-thalassaemia disease. Clin Endocrinol (Oxf). 2003;58(3):273-279. doi: https://doi.org/10.1046/j.1365-2265.2003.01707.x.
Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129. Available at: https://apps.who.int/iris/handle/10665/39142.
Cooley TB, Lee P. A series of cases of splenomegaly in children with anemia and peculiar bone changes. Trans Am Pediatric Soc. 1925;37:29-30.
Dresner Pollack R, Rachmilewitz E, Blumenfeld A, Idelson M, Goldfarb AW. Bone mineral metabolism in adults with beta-thalassaemia major and intermedia. Br J Haematol. 2000;111(3):902–907. doi: https://doi.org/10.1111/j.1365-2141.2000.02392.x.
Voskaridou E, Terpos E. New insights into the pathophysiology and management of osteoporosis in patients with beta thalassaemia. Br J Haematol. 2004;127(2):127-139. doi: https://doi.org/10.1111/j.1365-2141.2004.05143.x.
Karimi M, Ghiam AF, Hashemi A, Alinejad S, Soweid M, Kashef S. Bone mineral density in beta-thalassemia major and intermedia. Indian Pediatr. 2007;44(1):29-32.
Arjmandi Rafsanjani K, Razzaghy-Azar M, Zahedi-Shoolami L, Vossough P, Modarres A, Taheri N. Bone Mineral Density in β Thalassemia Major and Intermedia, Correlation with Biochemical and Hormonal Profiles. Iran J Blood Cancer. 2009;1(4):121-127. doi: http://ijbc.ir/article-1-1-en.html.
Terpos E, Voskaridou E. Treatment options for thalassemia patients with osteoporosis. Ann N Y Acad Sci. 2010;1202:237-243. doi: https://doi.org/10.1111/j.1749-6632.2010.05542.x.
Wong P, Fuller PJ, Gillespie MT, Milat F. Bone Disease in Thalassemia: A Molecular and Clinical Overview. Endocr Rev. 2016;37(4):320–346. doi: https://doi.org/10.1210/er.2015-1105.
Piga A. Impact of bone disease and pain in thalassemia. Hematology Am Soc Hematol Educ Program. 2017;2017(1):272–277. doi: https://doi.org/10.1182/asheducation-2017.1.272.
Abbasi S, Asl JF, Zadeh LM, Mirdoraghi M. Measurement bone mineral density (BMD) of patients with beta thalassemia. Data Brief. 2018;19:1021-1024. doi: https://doi.org/10.1016/j.dib.2018.05.120.
Shamshirsaz AA, Bekheirnia MR, Kamgar M, et al. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocr Disord. 2003;3(1):4. doi: https://doi.org/10.1186/1472-6823-3-4.
Bazi A, Harati H, Khosravi-Bonjar A, Rakhshani E, Delaramnasab M. Hypothyroidism and Hypoparathyroidism in Thalassemia Major Patients: A Study in Sistan and Baluchestan Province, Iran. Int J Endocrinol Metab. 2018;16(2):e13228. doi: https://dx.doi.org/10.5812%2Fijem.13228.
Nawar FK, Gamal, et al. Bone Mineral Density and Calcium Status in Children with β-Thalassemia. J Am Sci. 2014;10(8):197-205.
Dundar U, Kupesiz A, Ozdem S, Gilgil E, Tuncer T, Yesilipek A, et al. Bone metabolism and mineral density in patients with beta-thalassemia major. Saudi Med J. 2007;28(9):1425-1429.
Aslan I, Canatan D, Balta N, Kacar G, Dorak C, Ozsancak A, et al. Bone mineral density in thalassemia major patients from Antalya, Turkey. Int J Endocrinol. 2012;2012. doi: https://doi.org/10.1155/2012/573298.
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