Bone mineral density in children with beta-thalassemia major in Diyarbakir

Bone mineral status has extensively been investigated in adult thalassemics but less in thalassemic children. This study involves measurements of the bone mineral density (BMD), various demographic and biochemical parameters in 47 thalassemic children and 50 healthy controls with comparable age, sex, socioeconomic and regional distribution. Patients have significantly higher aspartate aminotransferase, alanine aminotransferase, phosphorous, osteocalcin, serum carboxy terminal teleopeptide fragment of type I collagen, intact parathyroid hormone (iPTH) and ferritin levels while they have significantly lower 25-hydroxy vitamin D (25OH-D), alkaline phosphatase and z-scores both at lumbar and femur compared to controls. Patients with high iPTH (30%) had significantly lower z-scores and 25OH-D while larger osteocalcin. We conclude that a significantly lower BMD in beta-thalassemic children compared with their healthy counterparts is a complex process and may partially attributed to their slower physical development, caused by iron overload and chelation therapy which may influence the liver as well as the endocrine tissues.

► Patients with beta-thalassemia major were found to have high PTH, low 25-hydroxy vitamin D and low z-scores. ► Some factors may be listed as the cause of the low body mineral density in thalassemia major. ► Some may be iron accumulation in the liver and iron deposition in bones. ► The others might be the inhibition of ALP by desferrioxamine and less likely the dysfunctions of endocrine organs. ► Precautions and questioning the current treatment protocols should be kept in mind for thalassemic patients, heavily depending on blood transfusion.