Many Sickle Cell Patients Have Weak Bones


SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.

“Iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology. “We need to look in more detail at transfused vs. nontransfused patients and see whether the iron overload story holds out.”

Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.

For the study, the investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had previously been transfused or were currently on a transfusion program. The investigators also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah, of the department of hematology at Whittington Hospital NHS Trust, London.

Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two had osteoporosis and two were osteopenic). Liver iron concentrations were higher among osteopenic females than in their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.

Among males in the study, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of the serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.

Overall, 47% of the study participants had osteopenia.

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