Gupta Sonia, Bhargava Siddharth, Kumar Rajesh, Kakkar Shruti
Associate Professor, Department of Immunohematology and Transfusion Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Associate Professor, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
J Assoc Physicians India. 2025 Jun;73(6):40-44. doi: 10.59556/japi.73.1029.
BACKGROUND: Bone disease is an increasingly recognized complication in patients with transfusion-dependent thalassemia (TDT). Multiple factors contribute to impaired bone metabolism, including bone marrow expansion, iron overload, chelation toxicity, calcium and vitamin D deficiencies, and endocrine disturbances, particularly hypogonadism. AIM AND OBJECTIVE: To evaluate the correlation between serum ferritin levels and bone mineral density (BMD) in patients with TDT. MATERIALS AND METHODS: This retrospective observational study was conducted at the Thalassemia Day Care Center of a tertiary care hospital in Punjab, India, from January to December 2022. All TDT patients aged >5 years who had undergone BMD assessment were included. BMD was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA). Z-scores were used for patients below 20 years, while T-scores were applied for those above 20 years. BMD results were categorized as normal, osteopenia, or osteoporosis. Anthropometric data (age, weight, and height), serum ferritin, calcium, phosphorus, alkaline phosphatase, and vitamin D levels were recorded and correlated with BMD. RESULTS: A total of 124 patients were included, with a mean age of 15.65 ± 9.09 years (range: 5-50 years). At the femoral neck, BMD was normal in 37%, osteopenic in 60%, and osteoporotic in 3.2% of patients. At the lumbar spine, normal BMD was observed in 20.9%, osteopenia in 61.2%, and osteoporosis in 17.7%. The 10-20 years age-group had the highest prevalence of bone loss ( = 0.099). Serum ferritin levels were significantly higher in patients with osteoporosis compared to those with osteopenia and normal BMD at both femoral neck (4 794.75 ± 2 637.82 vs 2 915.86 ± 1 360.20 vs 1 797.85 ± 1 304.89 ng/mL; < 0.001) and lumbar spine (4 627.50 ± 1 282.97 vs 2 454.03 ± 1 116.80 vs 1 128.58 ± 702.83 ng/mL; < 0.001). Receiver operating characteristic (ROC) curve analysis yielded an area under the curve (AUC) of 0.873 (95% CI: 0.795-0.950), with a ferritin cutoff of 1918 ng/mL (sensitivity: 80.4%, specificity: 87.5%). CONCLUSION: The study revealed a substantial prevalence of low BMD among TDT patients, particularly at the lumbar spine. Elevated serum ferritin levels were strongly associated with osteopenia and osteoporosis, indicating the impact of iron overload on bone health. Early and routine BMD assessments are recommended for timely identification and management of bone complications in this population.
背景：骨病是依赖输血的地中海贫血（TDT）患者中一种日益被认识到的并发症。多种因素导致骨代谢受损，包括骨髓扩张、铁过载、螯合毒性、钙和维生素D缺乏以及内分泌紊乱，尤其是性腺功能减退。 目的：评估TDT患者血清铁蛋白水平与骨密度（BMD）之间的相关性。 材料与方法：这项回顾性观察研究于2022年1月至12月在印度旁遮普邦一家三级护理医院的地中海贫血日间护理中心进行。纳入所有年龄>5岁且接受过BMD评估的TDT患者。使用双能X线吸收法（DXA）测量腰椎和股骨颈的BMD。20岁以下患者使用Z评分，20岁以上患者使用T评分。BMD结果分为正常、骨量减少或骨质疏松。记录人体测量数据（年龄、体重和身高）、血清铁蛋白、钙、磷、碱性磷酸酶和维生素D水平，并与BMD进行相关性分析。 结果：共纳入124例患者，平均年龄为15.65±9.09岁（范围：5 - 50岁）。在股骨颈，37%的患者BMD正常，60%骨量减少，3.2%骨质疏松。在腰椎，20.9%的患者BMD正常，61.2%骨量减少，17.7%骨质疏松。10 - 20岁年龄组的骨质流失患病率最高（P = 0.099）。与股骨颈骨量减少和BMD正常的患者相比，骨质疏松患者的血清铁蛋白水平显著更高（4794.75±2637.82 vs 2915.86±1360.20 vs 1797.85±1304.89 ng/mL；P < 0.001），腰椎也是如此（4627.50±1282.97 vs 2454.03±1116.80 vs 1128.58±702.83 ng/mL；P < 0.001）。受试者工作特征（ROC）曲线分析得出曲线下面积（AUC）为0.873（95%CI：0.795 - 0.950），铁蛋白临界值为1918 ng/mL（敏感性：80.4%，特异性：87.5%）。 结论：该研究显示TDT患者中BMD低的患病率很高，尤其是在腰椎。血清铁蛋白水平升高与骨量减少和骨质疏松密切相关，表明铁过载对骨骼健康有影响。建议对该人群进行早期和常规的BMD评估，以便及时识别和管理骨并发症。
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