ICCBH2019 Poster Presentations (1) (226 abstracts)
Use of DXA and pQCT measurements to screen for fracture risk in 3 to 18 year old poorly chelated thalassaemic children
Sonal Palande 1 , Veena Ekbote 1 , Shashi Chilplonkar 1 , Sujata Chauthmal 1 , Vaman Khadilkar 1 , Vijay Ramanan 2 , Anuradha Khadilkar 1 , Raja Padidela 3 , Zulf Mughal 3 & Nicola Crabtree 4
1Hirabai Cowasji Jehangir Medical Research Institute, Pune, India; 2Yashoda Hematology Clinic, Pune, Pune; 3Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital Manchester University NHS Foundation Trust, Mancheste, UK; 4Department of Diabetes and Endocrinology, Birmingham Women’s and Children’s NHS Foundation Trust, UK.
Objectives: Low bone mineral density has been reported in children with beta thalassemia major, they also have increased propensity to fracture. We have studied DXA and pQCT variables in poorly chelated 3 to 18 year old thalassaemic patients and their relationship with fractures in this population.
Methods: We studied 167, 3 to 18 year old children (Girls 72) with beta thalassemia major. Bone measurements were performed by GE iDXA (Lumbar Spine, Total body and vertebral fracture assessment and pQCT (Stratec XCT2000®, Radius 4%). Haemoglobin and serum ferritin were assessed. Fracture history was collected. VFA was carried out by the semiquantitative method described by Crabtree et al (2017). The DXA Lumbar spine and total body measurements were converted to Z-scores using a UK reference dataset. For the pQCT, machine generated Z-scores were used.
Results: The mean age was 11.6±3.9 yrs. The mean height, weight and BMI for age Z-scores were −1.9±1.2, −1.6±0.9 and −0.8±0.9 respectively. The mean Hb and s. ferritin concentrations were 8.1±1.7 g/dl and 2151.3±1894.9 ng/ml respectively. In all, fthere was history of fracture (vertebral or other) in 25% of children (38 with long bone fractures, 3 with vertebral fractures and 3 with both long bone and vertebral fractures). The mean lumbar spine BMAD and total body less head BMD for age Z-scores were significantly lower in fractured than non-fractured children, and were −0.8±1.8 and −0.2±1.5 for LSBMAD and, −2.3±1.2 and −1.4±1.3 for TBLHBMD respectively (P<0.05 for both). The mean trabecular bone density by pQCT for age z-score in fractured than non-fractured group were 1.2±1.5 and 1.8±1.5 respectively. The trabecular density appeared to be high as measured both by DXA (LS BMAD Z-score: majorly trabecular bone) and pQCT (trabecular density z-score) with classifying majority of children above the conventional cut-off of −2 (87% by DXA and 99% by pQCT).
Conclusion: In poorly controlled thalassaemic children DXA but, not pQCT parameters were significantly low in children who suffered fractures. The relatively high trabecular density by pQCT is likely to be due to iron deposition.
Disclosure: The authors declared no competing interests.
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