Bone Health Status among Thalassemia Children
Keywords:
Thalassemia children - Bone mineral density - Bone health status - QUS - Malaysia.Abstract
Introduction
Low bone mineral density is a significant problem in children with Thalassemia which may lead to increased risk for fragility fractures and suboptimal peak bone mass. This cross-sectional study was conducted to determine the bone health status of Thalassemia children Universiti Kebangsaan Malaysia Medical Centre and Paediatrics Insititute Kuala Lumpur Hospital.
Methods
A total of 81 respondents diagnosed with transfusion dependant beta Thalassemia (41 boys and 40 girls) aged between 7 to 19 years old completed the study. The data collected were demographic information, anthropometric measurements, dairy frequency questionnaires, dietary habits of the respondents and their parents, dietary intakes and bone densitometry using Ultrasound Bone Densitometer.
Results
For Quantitative Ultrasound (QUS) parameters, T-score of 9.8% participants were lower than -1.0 and 30.9% of the participants had lower Speed of Sound (SOS) than healthy SOS. This study showed there was no difference in bone density by sex (p>0.05). The median bone density of boys was 1616.00 m/ sec (IQR= 39.00) and girls’ was 1579.00 m/ sec (IQR= 116.00). SOS was not increased with age, height and weight; but girls’ Body Mass Index (BMI). Malay children had significantly higher SOS than non-Malay children.
Conclusions
This study highlights a need of proper intervention for the high risk group to achieve optimal bone health.
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References
Buison AM, Kawchak DA, Schall JI, Ohene-Frempong K, Stallings VA, Leonard MB, Zemel BS. Bone area and bone mineral content deficits in children with sickle cell disease. Pediatrics. 2005; 116: 943-949.
Vogiatzi MG, Macklin EA, Fung EB, Vichinsky E, Olivieri N, Kwiatkowski J, Cohen A, Neufeld E, Giardina PJ. Prevalence of fractures among the thalassemia syndromes in North America. Journal of Bone. 2004; 38: 571-575.
Benigno V, Bertelloni S, Baroncelli GI, Bertacca L, Di Peri S, Cuccia L, Borsellino Z, Maggio MC. Effects of thalassemia major on bone mineral density in late adolescence. J. Pediatr. Endocrinol. Metab. 2003; 16(2): 337-342.
George E. Editorial: Beta-thalassaemia major in Malaysia, an on-going public health problem. Med. J. Malaysia. 2001; 56.
Shamshirsaz AA, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, Habibzadeh MR, Hashemi R, Shamshirsaz AA, Aghakhani Sh, Homayoun H, Larijani B. Metabolic and endocrinologic complications in beta thalassemia Major: A multicenter study in Tehran. Biomedicine Central Endocrine Disorders. 2003; 3: 4.
Njeh CF, Boivin CM, Langton CM. The role of ultrasound in the assessment of osteoporosis: A review. Osteoporosis Int. 1997; 7: 7-22.
Zhu ZQ, Liu W, Xu CL, Han SM, Zu SY, Zhu GJ. Ultrasound bone densitometry of the calcaneus in healthy Chinese children and adolescents. Osteoporos Int. 2007; 18: 533–541.
WHO study group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical reports series, Geneva. 1994.
National Coordinating Committee on Food and Nutrition, Ministry of Health Malaysia. RNI, recommended nutrient intakes for Malaysia: a report of technical working group on nutritional guidelines. YKL Print, Shah Alam; 2005.
Jensen CE, Tuck SM, Agnew JE, Koneru S, Morris RW, Yardumian A, Prescott E, Hoffbrand AV, Wonke B. High prevalence of low bone mass in thalassaemia major. Bri J Haemat. 1998; 103: 911-915.
Anapliotou ML, Kastanias IT, Psara P, Evangelou EA, Liparaki M, Dimitriou P. The contribution of hypogonadism to the development of osteoporosis in thalassemia major: new therapeutic approaches. Clin Endocrinol. 1995; 42: 279-287.
Garofalo F, Piga A, Lala R, Chiabotto S, Di Stefano M, Isala GC. Bone metabolism in thalassemia. Ann NY Acad Sci. 1998; 850: 475-478.
Fadhli MS, Sazilah AS, Mehmet B. Quantitative ultrasound measurement of the calcaneus in Southeast Asian children with thalassemia. J Ultrasound Med. 2011; 30: 883-894.
National Osteoporosis Foundation. Physician’s guide to prevention and treatment ofosteoporosis. Washington DC: National Osteoporosis Foundation; 2003.
Wünsche K, Wünsche B, Fähnrich H, Mentzel HJ, Vogt S, Abendroth K, Kaiser WA. Ultrasound bone densitometry of the os calcis in children and adolescents. Calcif Tissue Int. 2000; 67: 349–355.
Pollitzer WS, Anderson JJB. Ethnic and genetic differences in bone mass: a review with a hereditary vs environmental perspective. Am J Clin Nutr. 1989; 50: 1244-1259.
Luckey NM, Meier DE, Mandeli JP, DaCosta MC, Hubbrad ML, Goldsmith SJ. Radial and vertebral bone density in white and black women: evidence for racial differences in premenopausal bone homeostasis. J Clin Endocrinol Metab.1989; 69: 762-770.
Seeman E. Editorial: growth in bone mass and size- are racial and gender differences in bone mineral density more apparent than real? J Clin Endocrinol Metab. 1998; 83(5): 1414-1419.
Looker AC. Editorial: the skeleton, race, and ethnicity. J Clin Endocrinol Metab. 2002; 87(7): 3047-2050.
Boot AM, DeRidder MAJ, Pols HAP, Krenning EP, DeMunick Keizer-Schrama SMPF. Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab. 1997; 82: 57-62.
Baroncelli GI, Federico G, Bertelloni S, Sodini F, De Terlizzi F, Cadossi R, Saggese G. Assessment of bone quality by quantitative ultrasound of proximal phalanges of the hand and fracture rate in children and adolescents with bone and mineral disorders. Pediatr Res. 2003; 54: 125–136.
Baltas CS, Balanika AP, Raptou PD, Tournis S, Lyritis GP. Clinical practice guidelines proposed by the Hellenic Foundation of Osteoporosis for the management of osteoporosis based on DXA results. J Musculoskelet Neuronal Interact. 2005; 5(4): 388-392.
Ndongo S, Sutter B, Ka O et al. Quantitative ultrasound measurements at the calcaneus in a population of urban Senegalese women: least significant difference and T-score. Rheumatology. 2012; 2: 107.
Vignolo M, Brignone A, Maseagni A, Ravera G, Biasotti B, Aicardi G. Influence of age, sex, and growth variables on phalangeal quantitative ultrasound measures: a study in healthy children and adolescents. Calcified Tissue International. 2003; 72: 681-688.
