Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia.
Osteoporosis in adult males is an under-recognized problem. Patients with haemophilia have several predisposing factors for developing decreased bone mineral density (BMD) including prolonged periods of immobility, reduced weight bearing and co-morbidities associated with bone loss. To establish prevalence and risk factors associated with decreased BMD in patients with haemophilia. Adults with moderate or severe haemophilia A or B underwent dual-energy X-ray absorptiometry (DXA). BMD was correlated to laboratory values, joint mobility measurements and physical activity questionnaires. Thirty patients completed evaluations. The median age was 41.5 years (range 18-61). Median lowest T-score by DXA was -1.7 (range: -5.8 to +0.6), with the femoral neck being the site of the lowest T-scores. Based on World Health Organization criteria, 70% of patients had decreased BMD. Twenty-seven per cent of the participants (n = 8) had osteoporosis and 43% (n = 13) had osteopenia. Variables associated with increased bone loss included lower serum 25-hydroxyvitamin D levels (P = 0.03), lower body mass index (P = 0.047), lower activity scores (P = 0.02), decreased joint range of motion (P = 0.046), HIV (P = 0.03), HCV (P = 0.02), history of inhibitor (P = 0.01) and age (P = 0.03). Adults with haemophilia are at increased risk for developing osteoporosis. A history of HCV and HIV infections, decreased joint range-of-motion, decreased activity levels, history of an inhibitor and low body weight predict bone loss and suggest a population to target for screening. A high prevalence of vitamin D insufficiency was observed. Future studies should investigate interventions, including vitamin D supplementation, to prevent bone loss and fractures for this at-risk population.
Gerstner
G
G
Arizona Hemophilia and Thrombosis Center, Arizona Cancer Center, Tucson, AZ 85724-5024, USA.
Damiano
M L
ML
Tom
A
A
Worman
C
C
Schultz
W
W
Recht
M
M
Stopeck
A T
AT
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000368:Aged; D001779:Blood Coagulation Factors / Q000009:adverse effects*; D015519:Bone Density / Q000502:physiology*; D005260:Female; D006467:Hemophilia A / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002836:Hemophilia B / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D015995:Prevalence; D011877:Radionuclide Imaging; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000150:complications / Q000000981:diagnostic imaging; D055815:Young Adult
D001779:Blood Coagulation Factors