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Vitamin D deficiency and osteoporosis in hemophilic children: an intermingled comorbidity
Hanaa H Eldash1, Zeze Th Atwa, Mohammad A Saad
1aDepartment of Pediatrics bDepartment of Radiology, University Hospital, Fayoum, Egypt.
Insights
Children with hemophilia often have lower bone mineral density due to vitamin D deficiency. Hemophilic arthropathy and immobility contribute to these bone health issues.
Area of Science:
- Pediatric Hematology
- Bone Metabolism
- Nutritional Deficiencies
Background:
- Hemophilia is a genetic bleeding disorder that can lead to joint damage and reduced mobility.
- Children with chronic illnesses are at risk for nutritional deficiencies impacting bone health.
- Understanding bone health in pediatric hemophilia is crucial for long-term management.
Purpose of the Study:
- To investigate the bone state in children with hemophilia.
- To identify factors influencing bone health in this population.
- To assess bone mineral density and associated biochemical markers.
Main Methods:
- A case-control study involving 37 children with hemophilia and 37 healthy controls.
- Evaluation of bone mineral density (BMD), serum vitamin D, parathormone, calcium, and phosphorus levels.
- Assessment of calcium creatinine ratio in serum and urine.
Main Results:
- Hemophilic children showed significantly lower bone mineral density (BMD) and vitamin D levels compared to controls (P<0.0001).
- Vitamin D deficiency was prevalent (43.2% moderate, 35.1% mild).
- Lower BMD correlated positively with age and negatively with joint damage scores. Higher urea, urinary calcium/creatinine ratio, and parathormone, with lower serum calcium, were observed in hemophilic children.
Conclusions:
- Vitamin D deficiency is a primary cause of reduced bone mineral density in children with hemophilia.
- Hemophilic arthropathy and immobilization significantly contribute to vitamin D deficiency and decreased bone mineral density.
- Interventions targeting vitamin D levels and managing arthropathy are essential for improving bone health in pediatric hemophilia.
Abstract:
The aim of this study is to investigate bone state and factors affecting it in children with hemophilia. This is a case-control study that included 37 children with hemophilia and 37 healthy controls. The patients were selected from the outpatient pediatric hematology clinic of Fayoum University Hospital, Egypt. Bone mineral density, serum vitamin D, parathormone, calcium, phosphorus, and calcium creatinine ratio levels were evaluated. Vitamin D level and bone mineral density were significantly lower in hemophiliacs than in control group (P < 0.0001). About 43.2% of cases had moderate vitamin D deficiency, whereas 35.1% had mild deficiency. Vitamin D positively correlated with bone mineral density Z-score, whereas it negatively correlated with total joint score. Positive correlation between bone mineral density and age was also found. Serum levels of urea, urinary calcium creatinine ratio, and parathormone were found to be higher in cases than in control. Also, serum calcium level was found to be lower in patients than in controls. We concluded that vitamin D deficiency is an essential cause of decreased bone mineral density in hemophilic children. Hemophilic arthropathy with consecutive immobilization plays an important role in vitamin D deficiency and decreased bone mineral density.
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