Dual X Ray absorptiometry is superior in detecting bone mineral density alterations in adult patients with thalassaemia major compared to quantitative computed tomography

Evangelos Alexiou, Michael Diamantidis, Katerina Vassiou, Ioannis Fezoulidis, Marianna Vlychou


Purpose: Patients with beta thalassaemia major are prone to develop osteoporosis during prolonged lifespan despite effective and regular chelation treatment. The present study aims to assess the bone mineral density in thalassaemic patients with dual x ray absorptiometry (DXA) and quantitative computed tomography (QCT), to assess the diagnostic performance of each method and correlate bone alterations with various clinical parameters and bone markers.

Material and Methods: The study included 75 homozygous thalassaemic adult patients (31 men, 44 women, age range 22-49 years) that were in regular transfusion and chelation therapy. All patients underwent DXA and QCT measurements and laboratory examinations. 

Results: First, we examined the relationship of lumbar Z scores at the lumbar spine between DXA and QCT measurements and there was no evidence of agreement between the two densitometric methods, in almost all cases. DXA measurements of the lumbar spine and femoral neck detected 24/75 patients (32%) and 10/75 patients (10%), respectively, below the expected range for age, indicative of diminished bone mineral density. Regarding bone markers and BMD, we found that ferritin has a statistically significant positive correlation with BMD of the femoral neck in both males and females. Similarly, osteocalcin has a statistically significant positive correlation with BMD of the femoral neck in male patients only.

Conclusions: Osteoporosis should be assessed only with DXA and should be taken into clinical consideration for monitoring and therapy in adult patients with thalassaemia.


bone mineral density, dual x ray absorptiometry, quantitative computed tomography, thalassemia major

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Gaudio A, Morabito N, Catalano A, et al: Pathogenesis of Thalassemia Major-associated Osteoporosis: A Review with Insights from Clinical Experience. J Clin Res Pediatr Endocrinol 2019; 11(2): 110-117.

Christenson RA, Pootrakul P, Burnell JM, et al: Patients with thalassemia develop osteoporosis, osteomalacia, and hypoparathyroidism, all of which are corrected by transfusion. Birth Defects Orig Artic Ser 1987; 23 (5A): 409-416

Vogiatzi MG, Autio KA, Schneider R, et al: Low bone mass in prepubertal children with thalassemia major: insights into the pathogenesis of low bone mass in thalassemia. J Pediatr Endocrinol Metab 2004; 17 (10): 1415-1421.

Fung EB, Vichinsky EP, Kwiatkowski JL, et al: Characterization of low bone mass in young patients with thalassemia by DXA, pQCT and markers of bone turnover. Bone 2011; 48(6): 1305-1312.

Shah N, Khadilkar A, Ekbote V, et al: DXA and pQCT derived parameters in Indian children with beta thalassemia major - A case controlled study. Bone 2021; 143:115730.

Angelopoulos NG, Katounda E, Rombopoulos G, et al: Evaluation of bone mineral density of the lumbar spine in patients with beta-thalassemia major with dual-energy x-ray absorptiometry and quantitative computed tomography: a comparison study. J Pediatr Hematol Oncol 2006; 28(2): 73-78.

Akpek S, Canatan D, Arac M, et al: Evaluation of osteoporosis in thalassemia by quantitative computed tomography: is it reliable? Pediatr Hematol Oncol 2001; 18(2): 111-116.

Allard HM, Calvelli L, Weyhmiller MG, et al: Vertebral Bone Density Measurements by DXA are Influenced by Hepatic Iron Overload in Patients with Hemoglobinopathies. J Clin Densitom 2019; 22(3): 329-337.

Tsartsalis AN, Lambrou GI, Tsartsalis DN, et al: Bone Metabolism Markers in Thalassemia Major-Induced Osteoporosis: Results from a Cross-Sectional Observational Study. Curr Mol Med 2019; 19(5): 335-341.

Ekbote V, Khadilkar A, Chauthmal S, et al: Assessment of Bone Density by DXA in Poorly Controlled Children With beta-Thalassemia: Correction for Hepatic Iron Overload by Manual Analysis. J Clin Densitom 2021; 24(3): 383-387

Angelopoulos NG, Goula A, Katounda E, et al: Markers of bone metabolism in eugonadal female patients with beta-thalassemia major. Pediatr Hematol Oncol 2007;

(7): 481-491.

Dede AD, Trovas G, Chronopoulos E, et al: Thalassemia-associated osteoporosis: a systematic review on treatment and brief overview of the disease. Osteoporos Int 2016; 27(12): 3409-3425.

Punzo F, Tortora C, Argenziano M, et al: Iron chelating properties of Eltrombopag: Investigating its role in thalassemia-induced osteoporosis. PLoS One 2018; 13(12): e0208102.

Rossi F, Perrotta S, Bellini G, et al: Iron overload causes osteoporosis in thalassemia major patients through interaction with transient receptor potential vanilloid type 1 (TRPV1) channels. Haematologica 2014; 99(12): 1876-1884.

Tzoulis P, Ang AL, Shah FT, et al: Prevalence of low bone mass and vitamin D deficiency in beta-thalassemia major. Hemoglobin 2014; 38(3): 173-178.

DOI: http://dx.doi.org/10.36162/hjr.v6i4.460


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