Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
Bone. 2018 Jan;106:121-125. doi: 10.1016/j.bone.2017.10.016. Epub 2017 Oct 18.
In thalassemia major or transfusion-dependent thalassemia patients, osteoporosis-related bone complications such as fracture events are common. However, no studies have investigated the risk of fracture in transfusion-naïve thalassemia population. Therefore, we conducted a longitudinal nationwide cohort study to determine whether this population has an increased risk of fracture. This nationwide, population-based cohort study analyzed data from 1998 to 2010 obtained from the Taiwanese National Health Insurance Research Database, with a follow-up period extending until the end of 2011. We identified cases with transfusion-naïve thalassemia and selected a comparison cohort that was frequency-matched according to age and year of diagnosis of thalassemia at a ratio of one subject with thalassemia to four subjects in the control group. We analyzed the risk of fracture events to occur in transfusion-naïve thalassemia cases by using Cox proportional hazards regression models. Totally, the study recruited 1369 transfusion-naïve thalassemia subjects and 5416 controls. We identified a total of 71 cases with fracture events within the thalassemia group and 204 within the control group. The overall risks for developing fracture events were 1.35-fold higher in transfusion-naïve thalassemia individuals than the comparison cohort after adjusting for age, sex and comorbidities. Most fracture events were observed in male transfusion-naïve thalassemia individuals rather than the normal population. In subgroup analysis, there was a 1.46-fold higher risk to develop upper-limb fracture in the thalassemia group than in the control groups. In conclusion, our long-term, cohort study results showed that there was a higher risk for the development of fractures in transfusion-naïve thalassemia individuals, particularly in male cases.
在重型或需要输血的地中海贫血患者中，与骨质疏松症相关的骨骼并发症（如骨折事件）较为常见。然而，目前尚无研究调查未输血的地中海贫血人群的骨折风险。因此，我们进行了一项纵向全国性队列研究，以确定该人群是否存在骨折风险增加。
这项全国性的基于人群的队列研究分析了来自 1998 年至 2010 年台湾全民健康保险研究数据库的数据，随访期延长至 2011 年底。我们确定了无输血史的地中海贫血患者，并选择了根据年龄和地中海贫血诊断年份以 1:4 的比例与对照组相匹配的频数匹配对照队列。我们使用 Cox 比例风险回归模型分析无输血史的地中海贫血患者发生骨折事件的风险。
共有 1369 名无输血史的地中海贫血患者和 5416 名对照者入选研究。在研究组中，共发现 71 例骨折事件，对照组中发现 204 例。在校正年龄、性别和合并症后，无输血史的地中海贫血患者骨折事件的总体风险比对照组高 1.35 倍。大多数骨折事件发生在无输血史的地中海贫血男性患者中，而非普通人群。亚组分析显示，地中海贫血组发生上肢骨折的风险比对照组高 1.46 倍。
总之，我们的长期队列研究结果表明，无输血史的地中海贫血患者骨折风险较高，尤其是男性患者。
