Abstract
Objective
This study aimed to detect metabolic bone disease and endocrinopathies in a cohort of patients with transfusion-dependent thalassemia (TDT).
Methods
This prospective study was conducted between March 2020–August 2021. Children with TDT older than 5 years, receiving regular blood transfusion, underwent comprehensive endocrine and metabolic bone disease evaluation, which included screening for short stature, delayed puberty, diabetes mellitus, hypothyroidism, adrenal insufficiency and hypoparathyroidism. Children older than 10 years also underwent. X-ray of thoracolumbar spine, and dual energy X-ray absorptiometry (DXA) scanning.
Results
Out of 37 patients (19 males), with mean (SD) age 15 (6) years, hypogonadism was the commonest endocrine deficiency seen in 15 (62%), followed by short stature, abnormal glucose metabolism, subclinical adrenal insufficiency, hypothyroidism, and hypoparathyroidism. Vitamin D insufficiency/deficiency was seen in 12 (60%) and hypocalcemia in 2 patients. Low bone mass was seen in 8, and osteoporosis, as evidenced by vertebral fractures, in 4 patients. Of the four patients with vertebral fracture, three were aged ≤18 years, one was symptomatic, two each had grade 1 and grade 2 fractures, one had multiple vertebral fractures, and all four had hypogonadism and multiple endocrine deficiencies.
Conclusion
Vertebral fractures occur even in the second decade among patients with TDT, and are often associated with endocrinopathies, most commonly hypogonadism. Early screening and prevention of vertebral fractures is necessary.
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Funding
Intramural Grants of Manipal Academy of Higher Education (MAHE), Manipal.
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Contributions
KH: conceptualized the study design, prepared the manuscript; KH, SA, GS, PK, RBY, SS: recruited patients, conducted endocrine studies; PS, KH: analyzed X-ray of spine. All the authors contributed to the final revision and approval of the manuscript.
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IEC, Kasturba Medical College and Hospital, Manipal; No. 235/2020, dated March 20, 2020.
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Competing interests
None stated.
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Handattu, K., Aroor, S., Kini, P. et al. Metabolic Bone Disease in Children With Transfusion-Dependent Thalassemia. Indian Pediatr 59, 920–923 (2022). https://doi.org/10.1007/s13312-022-2663-6
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DOI: https://doi.org/10.1007/s13312-022-2663-6