Bone Abstracts

Objectives: Bone disease is a long-term complication in patients with thalassaemia and therefore current UK guidelines recommend biannual bone density assessment from the age of 10 years. The aim of this study was to evaluate bone health in children with thalassaemia major.

Methods: Twenty-nine patients (11 boys) with a mean (S.D.) age of 13.07 year (2.29) with thalassaemia major had measurement of lumbar spine BMAD (L2-L4) and of total body less head BMD (TBLH BMD) using a GE Lunar iDXA. The presence of vertebral fractures (VF) was assessed by lateral spine DXA images, and vertebrae were graded using morphometric X-ray absorptiometry (MXA) in conjunction with the Genant scoring system. Detailed medical history and assessment of pubertal status was obtained from medical records. 25-OH-Vitamin-D (25OHD), ferritin and haemoglobin levels before transfusion were measured around the time of the scan.

Results: Mean (SD) BMAD Z-score of patients was −0.9 (1.0) with only three subjects (10.3%) having a Z-score below −2.0, and TBLH BMD Z-score was −1.6 (0.6) with 10 subjects (34.5%) having a Z-score below −2.0. In total, 377 vertebrae in 29 subjects were assessed. Eight subjects (27.6%) had 22 VF, six of whom had normal BMAD Z-scores. Seventeen VF were mild (20–25% vertebral height reduction) and five were moderate (25–40% vertebral height reduction). Two patients had ≥5 VFs one of whom was started on bisphosphonate treatment. Although there was a trend towards lower BMAD z-score and 25OHD levels in children with VF, there were no significant differences in lumbar BMAD z-score, TBLH BMD z-score, 25OHD, ferritin and haemoglobin between subjects with or without VF.

Conclusion: This study has shown that despite normal lumbar spine BMAD in the majority of subjects, VFs were present in 27.6%. Therefore, current guidelines for bone health monitoring in thalassaemia should be revised to ensure spinal imaging is included in order to detect vertebral fractures.

Disclosure: The authors declared no competing interests.