Service de Rhumatologie et Pathologies osseuses, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
INSERM UMR1033, Université de Lyon, Lyon, France.
Bone. 2024 Jan;178:116924. doi: 10.1016/j.bone.2023.116924. Epub 2023 Oct 17.
Bone fragility in sickle cell disease (SCD) has been previously reported even in young patients, but the clinical consequences and specific management remain unclear. The objective of this study was to assess the prevalence of bone fragility in sickle cell patients and to evaluate the potential risk factors and associated complications.
We conducted a single-center cross-sectional study. Bone mineral densitometry (BMD) at the lumbar spine and the hip, Vertebral Fracture Assessment (VFA) and biological measurements were performed in patients aged between 20 and 40 years.
One hundred and thirty-eight patients with sickle cell disease were included between June 2020 and December 2021. One hundred and one patients (73.2 %) were from Sub-Saharan Africa, 13 from North Africa (9.4 %), 11 from the Caribbean (7.9 %), 6 from the Indian Ocean. A Z-score < -2 was found in 43 patients (31.2 %) at the lumbar spine, in 4 patients (3 %) at the total hip, and in 5 patients (3.7 %) at the femoral neck. 59 patients (46.8 %) had vertebral deformities. Fragility fractures were recorded in 9 patients (10.8 %). Patients with low BMD had lower BMI (21.3 (19.0, 24.0) versus 24.0 (20.7, 26.1) Kg/m, p = 0.003), lower osteonecrosis history (7 % versus 25.3 %, p = 0.011) and lower hemoglobin levels (9.0 (8.0, 10.0) versus 10.0 (9.0, 11.0) g/dL, p < 0.01). No association was found between history of fracture and low BMD.
Young patients with SCD commonly have low BMD at the lumbar spine, but the prevalence of fragility fracture was low. Low BMD - specifically at the spine - may not be tantamount to bone fragility.
先前有报道称，镰状细胞病（SCD）患者即使在年轻时也存在骨脆弱，但临床后果和具体管理仍不清楚。本研究的目的是评估镰状细胞病患者骨脆弱的发生率，并评估潜在的危险因素和相关并发症。
我们进行了一项单中心横断面研究。在 20 至 40 岁的患者中进行腰椎和髋关节的骨矿物质密度（BMD）、椎体骨折评估（VFA）和生物测量。
2020 年 6 月至 2021 年 12 月期间，共纳入 138 例镰状细胞病患者。101 例（73.2%）来自撒哈拉以南非洲，13 例来自北非（9.4%），11 例来自加勒比地区（7.9%），6 例来自印度洋地区。43 例（31.2%）患者腰椎 BMD 评分低于-2，4 例（3%）患者全髋关节 BMD 评分低于-2，5 例（3.7%）患者股骨颈 BMD 评分低于-2。59 例（46.8%）患者存在椎体畸形。9 例（10.8%）患者记录到脆性骨折。低 BMD 患者的 BMI 较低（21.3（19.0，24.0）与 24.0（20.7，26.1）kg/m，p=0.003），骨坏死史较少（7%与 25.3%，p=0.011），血红蛋白水平较低（9.0（8.0，10.0）与 10.0（9.0，11.0）g/dL，p<0.01）。骨折史与低 BMD 之间无关联。
年轻的 SCD 患者腰椎普遍存在低 BMD，但脆性骨折的发生率较低。低 BMD - 特别是在脊柱 - 可能并不等同于骨脆弱。
