Bone Density in Thalassemic Children during the Course of the Disease

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Abstract
Summary: The study was carried out on 50 thalassemic children and 20 control subjects aged 5–15 years. The cortical thickness in thalassemic children was less than in control subjects. The bone loss was more obvious in girls (P < 0.0005) than in boys (P < 0.05). The greater bone loss in girls could not be explained by the level of blood hemoglobin because in both sexes the mean value was the same (7.3 ± 0.5 g/dl). Of the 12 thalassemic children observed for 9–24 months, 9 showed no significant bone change, 2 showed an improvement of cortical thickness and only 1 showed bone loss. Of the 11 thalassemic children observed for 25–48 months, 4 showed significant bone loss and 7 no change of the bone density. In both groups the mean value of pretransfusion blood Hb was 7.3 g/dl and the sex distribution was equal. A relationship was found in both control and thalassemic children between bone density and urine phosphorus to urine creatinine ratio. Speculation: The bone density is less in thalassemic than in control children and this difference is more obvious in girls. An investigation of the hormonal factors which are related to the bone density might give useful information concerning the hormonal status during the prepubertal period in thalassemic girls. This knowledge may help in preventing the severe bone loss in girls. The findings of the investigation may have more practical application in thalassemic girls, who do not need blood transfusions because they have blood hemoglobin values of 7–10 g/dl, but who have the bone lesions of thalassemia. In each individual patient the bone loss requires more than 24 months to become radiologically obvious when the pretransfusion blood hemoglobin is 7–8 g/dl. The bone loss during the course of the disease could be reduced with higher pretransfusion blood hemoglobin values with the complication of iron overload. From a previous study it was shown that thalassemic children have abnormally high phosphaturia. It is therefore likely that phosphorus administration could have beneficial effect on the bone density. Further investigations should be performed to assess the beneficial effect of different pretransfusion blood hemoglobin values and/or the extra oral phosphorus administration on the bone density in thalassemic children. Apart from the metabolism of phosphorus, that of calcium should also be investigated in thalassemic patients. It will be advisable to measure both ratios (UP:UCr and UCa:UCr) and to relate them to bone density. If a relationship is found then these two ratios can replace the radio-logic examination.

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