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Bone-related complications of transfusion-dependent beta thalassemia among children and adolescents

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Abstract

Thalassemia and the blood transfusion complications associated with it predispose children to poor bone health. This study was conducted to determine the prevalence of bone-related abnormalities and identify the bone health predictors within this population. One hundred and forty transfusion-dependent beta thalassemic subjects 8–18 years old in Mashhad, Iran, participated in this cross-sectional study. Anthropometric measures, dietary intake, bone-related biomarkers and bone densitometry, were assessed. The incidence of underweight and short stature was 33.6 and 41.4 %, respectively, which were indicators of malnutrition among thalassemic subjects in this study. Low bone density was detected in the lumbar spine and femoral region in 82 and 52 % of subjects, respectively. Hypocalcemia and hypophosphatemia were seen in 22 and 18.2 %, whilst vitamin D deficiency was present in more than 85 % of thalassemic children and adolescents. The relationships between weight, height and other anthropometric indices, serum calcium and bone markers, intake of macronutrients, zinc and vitamin E with bone mineral density (BMD) and bone mineral content (BMC) in the lumbar spine and femoral area were positively related, indicating that better nutritional status were associated with higher BMD and BMC values. Puberty, gender and serum osteocalcin were negative predictors for BMD and BMC values, whereas age, weight and height were the positive predictors. High incidence of low bone density and deficit in other aspects of bone health among thalassemia patients makes routine bone health assessment necessary for this vulnerable group. Considering influencing factors, dietary counseling and preventive supplementation therapy for this high risk group of children and adolescents may be necessary, although this should be assessed by intervention studies.

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Acknowledgments

This research project was financially supported by the Mashhad University of Medical Science Research Council and Iran National Science Foundation. The contribution of the staff of the Avicenna (Bu-Ali) Research Institute, Biochemistry and Nutrition Department of the Mashhad University of Medical Science, Iran National Science Foundation (INSF), Pharmacy faculty, Noor bone densitometry center, Sarvar clinic and lab, Sadra lab and Nutrition and Dietetics Department of the Universiti Kebangsaan Malaysia is gratefully acknowledged. Scientific editing of Prof Gordon Fern is gratefully appreciated.

Conflict of interest

All authors have no conflict of interest.

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Authors and Affiliations

  1. Dietetic Programme, Centre for Health Care Sciences, University Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia

    Naghmeh Zahra Mirhosseini & Suzana Shahar

  2. Faculty of Medicine, Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences (MUMS), Azadi Square, Pardis, Mashhad, Iran

    Naghmeh Zahra Mirhosseini & Majid Ghayour-Mobarhan

  3. Hematology-Oncology Department, Dr. Sheikh Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

    Abdullah Banihashem

  4. Internal Medicine Department, Hospital of University Kebangsaan Malaysia, Kuala Lumpur, Malaysia

    Nor Azmi Kamaruddin

  5. Internal Medicine Department, Imam Reza Hospital, Mashhad, Iran

    Mohammad Reza Hatef

  6. Department of Statistics, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

    Habib Alah Esmaili

Authors
  1. Naghmeh Zahra Mirhosseini
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  2. Suzana Shahar
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  3. Majid Ghayour-Mobarhan
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  4. Abdullah Banihashem
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  5. Nor Azmi Kamaruddin
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  6. Mohammad Reza Hatef
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  7. Habib Alah Esmaili
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Correspondence to Majid Ghayour-Mobarhan.

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Mirhosseini, N.Z., Shahar, S., Ghayour-Mobarhan, M. et al. Bone-related complications of transfusion-dependent beta thalassemia among children and adolescents. J Bone Miner Metab 31, 468–476 (2013). https://doi.org/10.1007/s00774-013-0433-1

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  • DOI: https://doi.org/10.1007/s00774-013-0433-1

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