Factors Contributing to Improved Bone Mineral Density in Patients With Transfusion-Dependent Thalassemia

Advances in therapy have extended the life expectancy of patients with thalassemia to near that of the general population; complications such as endocrine disorders and osteoporosis remain prevalent. This study aimed to identify endocrine complications, factors associated with endocrine complications, and changes in bone mineral density (BMD) in patients with transfusion-dependent thalassemia (TDT). This retrospective study reviewed medical records spanning over 10 years from patients aged 20-50 years with TDT, which included longitudinal follow-up data on thalassemia and endocrine function. Fisher's exact test was used for contingency tables, and univariate and multivariate binary logistic regression analyses were performed to identify contributing factors. A total of 44 patients were included, 81.8% of whom had at least one endocrine complication; osteoporosis was the most common (56.8%). All patients with a shorter blood transfusion interval (≤ 28 days) had thalassemia major. Shorter transfusion interval was significantly associated with a higher incidence of diabetes mellitus (DM) and female hypogonadism and a lower proportion of patients free of endocrine complications. No factor was statistically associated with osteoporosis in our study. 54.5% patients with osteoporosis had spontaneous improved BMD without pharmacological treatment. Vitamin D and calcium supplementation for > 1 year and absence of DM were linked to improved BMD in univariate analysis, but only absence of DM remained significantly associated in multivariate analysis. In conclusion, this study is based on real-world clinical data and has several limitations. The incidence of endocrine complications was high among patients with TDT. Osteoporosis was the most common endocrine complication. Absence of DM was associated with greater improvement in BMD of TDT patients with osteoporosis.