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Published on: January 29, 2018
Prevalence and risk factors predisposing low bone mineral density in patients with thalassemia
Natnicha Ananvutisombat1, Adisak Tantiworawit2,3, Teerachat Punnachet2
1Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
Low bone mineral density (BMD) affects over 60% of thalassemia patients, particularly females and those requiring transfusions. Lower BMI and transfusion dependency are key risk factors for low BMD in this population.
Area of Science:
- Endocrinology
- Hematology
- Bone Metabolism
Background:
- Thalassemia, a group of inherited blood disorders, frequently leads to secondary osteoporosis.
- Low bone mineral density (BMD) is a significant complication impacting patient quality of life.
Purpose of the Study:
- To determine the prevalence of low BMD in thalassemia patients.
- To identify clinical factors associated with low BMD in this cohort.
Main Methods:
- A cross-sectional study was conducted on 210 thalassemia patients (males 18-49 years, premenopausal females).
- Low BMD was diagnosed using dual-energy x-ray absorptiometry (DXA) with a Z-score ≤ -2.0 SD.
- Logistic regression analysis identified factors associated with low BMD.
Main Results:
- The prevalence of low BMD was 62.4% in the study population.
- Transfusion dependency (OR 2.36) and lower body mass index (BMI) (OR 0.71) were independently associated with low BMD.
- In the low BMD subgroup, hypogonadism, low serum IGF-1, and altered serum phosphate levels correlated with lower Z-scores.
Conclusions:
- A high prevalence of low BMD exists in thalassemia patients.
- Transfusion dependency and BMI are significant predictors of low BMD.
- Endocrine and metabolic factors like hypogonadism, IGF-1, and phosphate levels are linked to reduced bone density.
Background:
A common complication of thalassemia is secondary osteoporosis. This study aimed to assess the prevalence and factors associated with low BMD in thalassemic patients.
Method:
This is a cross-sectional study. Eligible patients were males aged within 18-49 years or premenopausal women diagnosed with thalassemia in Chiang Mai University Hospital between July 2021 and July 2022. The diagnosis of low BMD by dual-energy x-ray absorptiometry (DXA) was defined as a Z-score of -2.0 SD or lower in either the lumbar spine or femoral neck. Clinical factors associated with low BMD were analyzed using a logistic regression model.
Results:
Prevalence of low BMD was 62.4% from 210 patients with a mean age of 29.7 ± 7.6 years. The predominant clinical characteristics of low BMD thalassemia patients were being female, transfusion-dependent (TDT) and a history of splenectomy. From multivariable analysis, the independent variables associated with low BMD were transfusion dependency (odds ratio, OR 2.36; 95%CI 1.28 to 4.38; p=0.006) and body mass index (BMI) (OR 0.71; 95%CI 0.61 to 0.82; p<0.001). Among patients with low BMD, we observed a correlation between a Z-score with low IGF-1 levels (β=-0.42; 95% CI -0.83 to -0.01; p=0.040), serum phosphate levels (β=0.40; 95% CI 0.07 to 0.73; p=0.016) and hypogonadism (β=-0.48, 95% CI -0.91 to -0.04, p=0.031).
Conclusion:
This study found a prevalence of low BMD in 62.4% of subjects. Factors associated with low BMD were TDT and BMI. Within the low BMD subgroup, hypogonadism, serum phosphate and low serum IGF-1 levels were associated with a lower Z-score.
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