Engkakul Pontipa, Mahachoklertwattana Pat, Jaovisidha Suphaneewan, Chuansumrit Ampaiwan, Poomthavorn Preamrudee, Chitrapazt Niyata, Chuncharunee Suporn
Departments of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
J Pediatr Hematol Oncol. 2013 Apr;35(3):212-7. doi: 10.1097/MPH.0b013e3182841574.
Osteoporosis is a common problem in thalassemics. As the most affected bone is spinal vertebrae, theoretically, it should have the greatest risk of fracture. However, vertebral fracture (VF) in thalassemics was rarely reported. Screening for asymptomatic VF in thalassemics has not been reported. We, therefore, evaluated prevalence of VF in adolescents and young adults with thalassemia. A total of 150 patients with thalassemia, aged 10 years and older were enrolled. Lateral thoracolumbar spine radiography was evaluated. Twenty patients (13%) had VF and 6 of 20 (30%) had multiple VFs. The 2 most common sites of VF were lumbar 1 and thoracic 12 vertebrae. Comparing with the group without VF, thalassemics with VF were older, had more severe degree of thalassemia, history of splenectomy and previous non-VF, more iron chelation use, and longer duration of blood transfusion, but had lower pretransfused hematocrit. Multivariate analysis revealed 2 predictive factors for VF, having severe thalassemia and aged 20 years or older (odds ratio 5.7 and 5.0, respectively). In conclusion, unrecognized asymptomatic VF in thalassemics was not uncommon. Risk factors associated with VF included severe thalassemia and age 20 years or older. Screening for VF in the high-risk patient should be considered.
骨质疏松症是地中海贫血患者中的常见问题。由于受影响最严重的骨骼是脊椎，理论上，其骨折风险应该最高。然而，地中海贫血患者的椎体骨折（VF）却鲜有报道。尚未有关于筛查地中海贫血患者无症状椎体骨折的报道。因此，我们评估了青少年和青年地中海贫血患者椎体骨折的患病率。共纳入了150例年龄在10岁及以上的地中海贫血患者。对胸腰椎侧位X线片进行了评估。20例患者（13%）发生椎体骨折，其中6例（30%）为多发性椎体骨折。椎体骨折最常见的两个部位是腰1椎体和胸12椎体。与无椎体骨折的患者组相比，发生椎体骨折的地中海贫血患者年龄更大、地中海贫血程度更严重、有脾切除术史和既往非椎体骨折史、更多使用铁螯合剂、输血时间更长，但输血前血细胞比容更低。多变量分析显示椎体骨折的两个预测因素为重度地中海贫血和年龄在20岁及以上（比值比分别为5.7和5.0）。总之，地中海贫血患者未被识别的无症状椎体骨折并不少见。与椎体骨折相关的危险因素包括重度地中海贫血和年龄在20岁及以上。应考虑对高危患者进行椎体骨折筛查。
