Increased prevalence of fractures in inadequately transfused and chelated Indian children and young adults with beta thalassemia major

Ekbote, Veena; Padidela, Raja; Khadilkar, Vaman; Ramanan, Vijay; Maheshwari, Ankita; Mughal, Zulf; Kariki, Eleni P.; Crabtree, Nicola; Khadilkar, Anuradha

Abstract

Introduction
In patients with beta thalassemia major, inadequate transfusion and chelation may compromise bone health and increase risk of fractures. The objective of this study was to describe the prevalence of fractures in Indian inadequately transfused and chelated children, adolescents and young adults with beta thalassemia major.

Methods
We studied 179 patients with beta thalassemia (3.6–28.3 years; 105 boys). Medical, transfusion, chelation and fracture history were recorded. Vertebral fracture assessment (VFA) was performed using lateral spine images acquired using the GE Lunar iDXA (Wisconsin, MD). Fractures were classified according to an adapted semi-quantitative method.

Results
History of non-traumatic long bone fractures was observed in 21% patients (n = 37); there were significantly greater (p < 0.05) number of males (n = 30) than females (n = 15). The 21% fracture prevalence in the present study is higher than the reported fractures of 9% in healthy Indian children and adolescents. The prevalence of vertebral fractures was 4.5% (n = 8) in the study group. Of those with fractures, four patients had both long bone and vertebral fractures, and (any, long bone or vertebral fractures) sixteen patients had more than 1 fracture; eleven patients had 2 fractures, four patients had 3 fractures and one patient had 5 fractures. Thus, in 179 patients, there were a total of 68 single fractures which translates to 307 fractures per 10,000 patient years.

Conclusion
This study found increased prevalence of non-traumatic long bone and vertebral fractures in children and adolescents with thalassemia major.

Citation

Ekbote, V., Padidela, R., Khadilkar, V., Ramanan, V., Maheshwari, A., Mughal, Z., …Khadilkar, A. (2021). Increased prevalence of fractures in inadequately transfused and chelated Indian children and young adults with beta thalassemia major. BONE, 143, 115649. https://doi.org/10.1016/j.bone.2020.115649

• Journal Article Type: Article
• Acceptance Date: Sep 12, 2020
• Online Publication Date: Sep 18, 2020
• Publication Date: 2021-02
• Deposit Date: Jun 2, 2023
• Journal: Bone
• Print ISSN: 8756-3282
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 143
• Pages: 115649
• DOI: https://doi.org/10.1016/j.bone.2020.115649
• Keywords: Histology; Physiology; Endocrinology, Diabetes and Metabolism
• Additional Information: This article is maintained by: Elsevier; Article Title: Increased prevalence of fractures in inadequately transfused and chelated Indian children and young adults with beta thalassemia major; Journal Title: Bone; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.bone.2020.115649; Content Type: article; Copyright: © 2020 Elsevier Inc. All rights reserved.