Osteopenia and Osteoporosis in Children and Adolescents with Beta Thalassemia Major

Abstract

Background; Osteopenia and osteoporosis in beta thalassemia major cases start early in life and increases the risk of fractures. It enhances morbidity, adds to the injury of patients and parents/caregivers and burdens the health care system.

Objective; To assess prevalence of decreased bone mineral density (osteopenia and osteoporosis) in children and adolescents with beta thalassemia major.

Cross-sectional study

Methods; The cross-sectional study was carried out at DHQ Hospital Zhob from May 2021 to December 2021. Children and adolescents (5-18 years of age) with beta thalassemia major were included. Bone mineral density was measured using Z-score by Dual Energy X-ray Absorptiometry (DEXA-Scan). Z-Scores results were categorized into normal (Z-score < -1), osteopenia (Z score -1 to -2.5 ) and osteoporosis (Z-score > -2.5). Hemoglobin levels (g/dL), serum calcium (mmol/L), vitamin D levels (ng/mL) and ferritin levels (ng/dL) were carried out for all the participants. The data was entered in Statistical package for social sciences 21 and analyzed.

Results; Out of 82 patients, there were 44(53.7%) males and 38(46.3%) females. Mean age was 11.5 + 4.24 years.  The DEXA-Scan results identify; all had decreased bone mineral density, 42.7% were having osteopenia and 57.3% were having osteoporosis. There was a significant decrease in bone mineral density in higher age group (p<0.001) and in children with higher serum ferritin level (p=0.042).

Conclusion; Beta thalassemia major patients start developing bone demineralization in young age and progresses with age. The decrease in bone mineral density was significantly related to higher serum ferritin levels.