Prevalence of osteoporosis & osteopenia in transfusion-dependent thalassemia in Sulaimaniyah city, Iraq

Hunar Gharib  Mahmood; Ahmad Khudair  Yassin; Zeki Ali  Mohamed

doi:10.56056/amj.2024.261

Authors

Hunar Gharib Mahmood MBChB, Trainee of KHCMS Clinical Hematology, Center of Thalassemia and Congenital Blood Disorder, Directorate of Health, Sulaimaniyah, Iraq. Corresponding author’s
Ahmad Khudair Yassin MBChB, DM, CABM, FIBMS, FRCP, Professor of Hemato-oncology, College of Medicine, Hawler Medical University and Nanakali Hospital for Hematology and Cancer, Erbil, Iraq.
Zeki Ali Mohamed MBChB, FIBMS, MRCP & FRCP (London). Assistant Professor of Hemato-oncology, Consultant Clinical Hematologist, Azadi Hematology/Oncology Center and Department of Internal Medicine and Clinical Hematology, College of Medicine, University of Duhok, Duhok, Iraq.

DOI:

https://doi.org/10.56056/amj.2024.261

Keywords:

Osteoporosis, Retrospective study, Transfusion dependent thalassemia

Abstract

Background and objectives: Although blood transfusion and iron chelation increase the lifespan of thalassemic patients, these patients face many complications, including osteoporosis and osteopenia. Thus, we aimed to determine prevalence rates of osteoporosis/osteopenia using Dual Energy X-Ray Absorptiometry in transfusion-dependent thalassemia patients and its relationship with chelation agents and body mass index.

Methods: This retrospective study included 150 patients with transfusion-dependent thalassemia in the Thalassemia and Congenital Blood Disorders Center, Sulaimaniyah, Iraq, from December 2021 to July 2022. The participant’s information was collected from the hospital database, including sociodemographic characteristics, bone mineral density status, and the number of items used for chelation. A Dual Energy X-Ray Absorptiometry bone scan was used to check the bone mineral density.

Results: The mean age of patients was 19.59±7.59, body mass index was 21.23±18.13, and most (53.3%) were females. Dual Energy X-Ray Absorptiometry results showed that 53.3% of the patients had osteopenia, 21.3% had osteoporosis, 36.7% had average bone mineral density, and 6.7% had low bone mineral density for age. In addition, there was a significant difference between the frequencies of bone density disorders in patients who used one chelating agent (46.4%) versus two chelating agents (85%) (P?0.001). Also, there was a significant difference between the incidence of bone density disorders with low and average body mass index (78%) in comparison with overweight and obese patients (8%) (P?0.001).

Conclusions: There is a high prevalence of osteoporosis and osteopenia in transfusion-dependent thalassemia patients, which are more prone to trauma and bone fracture.

Downloads

Download data is not yet available.

References

Kumar M, Purohit A, Pramanik S, et al. Evaluation of Factors Affecting Awareness About Beta-Thalassemia in Western Rajasthan. J Family Med Prim Care. 2020; 9(9):4801-4.

Cao A, Galanello R. Beta-thalassemia. Genet Med. 2010; 12(2):61-76.

Zhang L, Hongping H, Qin W. Relationships Between Beta Thalassemia and Polymorphism of Bcl11a Gene. Acta Med Mediterr. 2020; 36(1):237-41.

Needs T, Gonzalez-Mosquera LF, Lynch DT. Beta thalassemia. StatPearls Publishing, Treasure Island (FL), 2018.

Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010; 5:1-15.

Aws H, Al-Numan S, Ghazwan Y. Screening of beta-thalassemia major patients below 18 years for acute cytomegalovirus infection by IgM serology in Mosul. Acta Med Mediterr. 2021; 37:1009.

Origa R. ?-Thalassemia. Genet Med. 2017;19(6):609-19.

Kadhim KA, Baldawi KH, Lami FH. Prevalence, incidence, trend, and complications of thalassemia in Iraq. Hemoglobin. 2017;41(3):164-8.

Al-Allawi N, Al Allawi S, Jalal SD. Genetic epidemiology of hemoglobinopathies among Iraqi Kurds. J Community Genet. 2021;12(1):5-14.

Hashemieh M, Azarkeivan A, Radfar M, et al. Prevalence of osteoporosis among thalassemia patients from Zafar adult thalassemia clinic, Iran. Iran J Blood Cancer. 2014;6(3):143-8.

Voskaridou E, Terpos E. Pathogenesis and management of osteoporosis in thalassemia. Pediatr Endocrinol Rev. 2008;6(1):86-93.

Cefalu CA. Is bone mineral density predictive of fracture risk reduction? Curr Med Res Opin. 2004;20(3):341-9.

Sözen T, Öz???k L, Ba?aran NÇ. An overview and management of osteoporosis. European J Rheumatol. 2017;4(1):46-56.

Motta I, Mancarella M, Marcon A, et al. Management of age-associated medical complications in patients with ?-thalassemia. Expert Rev Hematol. 2020;13(1):85-94.

Youssry I, Saad N, Madboly M, et al. Bone health in pediatric transfusion?dependent beta?thalassemia: Circulating osteoprotegerin and RANKL system. Pediatr Blood Cancer. 2022;69(1): e29377.

Shawkat AJ, Jwaid AH, Awad GM, et al. Evaluation of Osteopathy in Patients with Beta-Thalassemia Major Using Different Iron Chelation Therapies. Eval. 2018;11(11):1-5.

Jazuli MI, Bintoro SUY, Mudjanarko SW. The association between serum ferritin levels and 25 (OH) D levels in adult patients with transfusion-dependent thalassemia. J Med Chem Sci 2022;5(1):35-41.

Moustafa SR, Al-Hakeim HK, Alhillawi ZH, et al. In Transfusion-Dependent Thalassemia Children, Increased Iron Overload is Associated with Lower Serum Alpha-Klotho, Strongly Associated with Lower Total and Ionized Calcium Concentrations. Curr Mol. Med. 2023. doi: 10.2174/1566524022666220607163232.

Naithani R, Seth T, Tandon N, et al. Fractures and low bone mineral density in patients with beta-thalassemia major. Indian J Hematol Blood Transfus. 2018; 34:163-5.

Bordbar M, Omrani GR, Haghpanah S, et al. Bone mineral density in transfusion-dependent thalassemia patients and its associated factors in Southern Iran. Arch Osteoporos. 2020; 15:1-8.

AlSaadi E. Disturbances of Lipid Profile, Hemoglobin and Serum Ferritin Levels in Thalassemia Patients in Misan City, Amara, Iraq. J Med Chem Sci. 2022;5(5):779-86.

Ansaf A, Faraj S, Mohammed R. Bone mineral density in patients with thalassemia major, the experience of a single institute. Int J Res Pharma Sci. 2021;12(1):676-82.

Ansari-Moghadam AR, Adineh H, Zareban I, et al. Bone mineral density (BMD) and chemical biomarkers among patients with thalassemia major and intermedia in Iran. Health Scope. 2018;7(4): e64137.

Kharroubi A, Karmi B, Shamasneh W, et al. Bone mineral density among Palestinian patients suffering from hemoglobinopathy disorders. Arch Osteopor. 2020; 15:1-7.

Abbassy HA, Elwafa RAA, Omar OM. Bone mineral density and vitamin D receptor genetic variants in Egyptian children with beta-thalassemia major on vitamin D supplementation. Mediterr J Hematol Infect Dis. 2019;11(1): e2019013.

Al-Samkari H, Grace RF, Glenthoej A, et al. Early-onset osteopenia and osteoporosis in patients with pyruvate kinase deficiency. Blood. 2020; 136:30-2.

Nourmohammadi H, Daresh H, Shafiei E, et al. Complications of Tuberculosis Packs and Iron Chelators in Patients with Thalassemia Major in Mostafa Khomeini Hospital in 2018-19. J Med Chem Sci. 2022;5(4):619-23.

Lal A, Wong TE, Andrews J, et al. Transfusion practices and complications in thalassemia. Transfus. 2018;58(12):2826-35.

Ghanavat M, Haybar H, Pezeshki SMS, et al. Cardiomyopathy in thalassemia: a quick review from cellular aspects to diagnosis and current treatments. Lab Med. 2020;51(2):143-50.

Gaudio A, Morabito N, Catalano A, et al. Pathogenesis of thalassemia major-associated osteoporosis: a review with insights from clinical experience. J Clin Res Pediatr Endocrinol. 2019;11(2):110-7.

Feichtinger X, Kocijan R, Resch H, et al. Bone microarchitecture deteriorations and a fragility fracture in a patient with beta and alpha heterozygous thalassemia: a case report. Wien Klin Wochenschr. 2017; 129:212-6.

Stefanopoulos D, Papaioannou NA, Papavassiliou AG, et al. A contemporary therapeutic approach to bone disease in beta-thalassemia-a review. J Frailty Sarcopenia Falls. 2018;3(1):13.

Alswat KA. Gender disparities in osteoporosis. J Clin Med Res. 2017;9(5):382-7.

De Martinis M, Sirufo MM, Polsinelli M, et al. Gender differences in osteoporosis: A single-centre observational study. World J Mens Health 2021;39(4):750-9.

Modagan P, Silambanan S, Menon PG, et al. Comparison of bone mineral density with biochemical parameters and prevalence of osteopenia and osteoporosis in South Indian population. Biomed Pharmacol J. 2018;11(4):2209-14.