RISK FACTORS OF OSTEOPOROSIS AMONG ADULT THALASSEMIA PATIENTS IN RAJAVITHI HOSPITAL

Abstract

Background bone complications especially osteoporosis are very common in Thalassemia patients. The objectives of this study was to assess risk factors of osteoporosis among adult thalassemia intermedia and minors and its prevalence in randomly selected adult population Patients and Methods 190 adult thalassemia intermedias and minors was included in the descriptive cross-sectional study.Patients with untreated hypogonadism, untreated hypothyroidism , menopause and with history of treatment with medications that have effects on skeletal and bone metabolisms were excluded.BMD of femoral neck were measured by means of calibrated dual energy X-ray absorptiometry. Independent factors likely to be associated with osteoporosis were determined and included in the analysis to ascertain possible associations. Results Of 190 patients, 58 male and 132 female patients were included. Mean age was 35.48+14.11 years old(range 15-87). The Mean Z score of femoral neck was was -0.86+1.14 (range -3.7-2.40). prevalence of osteoporosis was 22/190(11.59%). Comparison by type of thalassemia and its severity (blood transfusion dependent or nor), Mean BMD Z Scores among 3 types of thalassemia were different including thalassemia intermedias with blood transfusion dependent -1.01+1.17, thalassemia intermedias with blood transfusion independent -0.97+1.16 and thalassemia minors -0.54+1.01, p=0.017. Correlation between the pretransfusion hemoglobin level and BMD score was r=0.192,p=0.008.By univariate analysis,this study showed low BMI was a risk factor for osteoporosis(OR=3.09,95%CI 1.09-8.76,p=0.039 ) and iron chelation therapy as a protective factor(OR=0.24,95%CI 0.09-0.69,p=0.005). In multivariate analysis, there were no significant factors. Conclusions: Regarding the high prevalence of osteoporosis in patients with thalassaemia, all patients at risk should be screened periodically for bone disease. The uncertainty and disagreements as to the potential role of different factors indicate the necessity for further studies in order to recognize the pathophysiologic basis of this serious complication of thalassaemia.