Hemophilia, low bone mass, and osteopenia/osteoporosis

A recent case series from Australia suggested that children with hemophilia may be more likely to have low bone density or osteopenia than healthy controls. This finding has led to uncertainty among patients and their physicians as to whether treatment with bisphosphonates is indicated to treat osteopenia and prevent osteoporosis in children or young adults with hemophilia. In fact, several studies confirmed that selected patients with hemophilia were shorter, weighed less, had reduced physical activity, and had other factors (hepatitis C and HIV seropositivity) which predict lower peak bone mass. Some of these factors may accelerate loss of bone mass between ages 20 and 50 when bone mass should otherwise be stable, but no study has yet confirmed if this is the case for patients with hemophilia. Treatment with weight-bearing physical activity, physiotherapy and surgery to remobilize diseased joints, and calcium and vitamin D supplementation, can be recommended for anyone at any age. Treatment with an antiresorptive medication (usually a bisphosphonate) is not indicated for low peak bone mass that will otherwise be maintained by the patient between ages 20 and 50. On the other hand, on an individualized basis, treatment with an antiresorptive may be indicated for patients in whom rapid loss of bone mass has been confirmed by sequential BMD measurements, or who have already suffered fragility fractures, or who have reached an age and BMD value that places them into a high-risk category for estimated 10-year fracture risk.