Unrecognized Vertebral Fractures in Adolescents and Young Adults With Thalassemia Syndromes

Abstract

Osteoporosis is a common problem in thalassemics. As the most affected bone is spinal vertebrae, theoretically, it should have the greatest risk of fracture. However, vertebral fracture (VF) in thalassemics was rarely reported. Screening for asymptomatic VF in thalassemics has not been reported. We, therefore, evaluated prevalence of VF in adolescents and young adults with thalassemia. A total of 150 patients with thalassemia, aged 10 years and older were enrolled. Lateral thoracolumbar spine radiography was evaluated. Twenty patients (13%) had VF and 6 of 20 (30%) had multiple VFs. The 2 most common sites of VF were lumbar 1 and thoracic 12 vertebrae. Comparing with the group without VF, thalassemics with VF were older, had more severe degree of thalassemia, history of splenectomy and previous non-VF, more iron chelation use, and longer duration of blood transfusion, but had lower pretransfused hematocrit. Multivariate analysis revealed 2 predictive factors for VF, having severe thalassemia and aged 20 years or older (odds ratio 5.7 and 5.0, respectively). In conclusion, unrecognized asymptomatic VF in thalassemics was not uncommon. Risk factors associated with VF included severe thalassemia and age 20 years or older. Screening for VF in the high-risk patient should be considered.

The Trabecular Bone Score as a Predictor for Thalassemia-Induced Vertebral Fractures in Northeastern Thailand

“…The prevalence of thalassemia-associated osteoporotic fractures in beta-thalassemia major and in the various thalassemia syndromes has not been well established This study demonstrated that the prevalence of vertebral fracture was 16.3% (14/86), which was comparable with a previous study by Engkakul et al, which reported that the prevalence of vertebral fracture was 13% in Thai patients with thalassemia [ 26 ] The prevalence of vertebral fractures in the present study, however, was slightly higher than that in a previous report from a large cohort study including 31 clinical centers in the United States, Canada, and the United Kingdom (16.3% vs. 10.6%) [ 21 ]. The discrepancy in prevalence among the studies might be explained by three main factors including (i) the differences in the diagnostic methods of vertebral fracture because in the previous study, fractures were assessed by the self-reported fracture history questionnaires, but in this cohort, vertebral fractures included both symptomatic and/or radiographic vertebral fractures; (ii) the enrolled subjects in this study were adult patients with a high iron burden, and about 20% of patients had iron-associated endocrinopathies.…”

Pathogenesis of Thalassemia Major-associated Osteoporosis: A Review with Insights from Clinical Experience

“…Extremity fractures are the most common (26), in particular at the upper extremity (31). Vertebral fractures are usually underestimated, and their prevalence varies from 2.6% to 13% (26,36).…”

High Prevalence of Bone Pain and Fractures in Young Transfusion Dependent Patients with β-Thalassemia at Southern Pakistan

“…Multiple and recurrent fractures were sustained on mild and moderate trauma as reported previously as well [19,20]. Asymptomatic vertebral fractures have been reported in thalassemia in patients above 20 years of age [21]. There is a prevalence of 40-80% demineralization of lumbar spine [22,23] associated with back ache in thalassemia [23].…”