title: Evaluation of osteopathy in thalassemia by bone mineral densitometry and biochemical indices.
abstract: OBJECTIVE
  To evaluate osteopathy in thalassemia by bone mineral densitometry (BMD) and biochemical indices.
  
  
  METHODS
  Prospective review analysis with no follow up from 2006 to 2007 of 42 regularly transfused thalassemics aged 10-25 years (27 boys, 15 girls) was done. Anthropometry, pubertal stage and symptomatology were noted. Urinary C-terminal cross-linked telopeptide of type-1 collagen (Crosslaps) by ELISA; serum 25-OH vitamin D and osteocalcin by RIA; parathyroid hormone (PTH) and ferritin by chemiluminescence and IGF-1 by Enzyme immunoassay were evaluated. Dual Energy X-ray Absorptiometry (DEXA) of lumbar spine and femur was done on Lunar prodigy system. Data was entered and analyzed using the SPSS for Windows software. Mean comparisons were done by ANOVA 1 and data was compared using Chi-square test and p value < 0.05 was taken as significant.
  
  
  RESULTS
  Of 42 patients, 81% had osteoporosis by Z-score of DEXA. Urinary crosslaps was high in 55%; 36% had increased osteocalcin; 62% had low vitamin D levels; 38% had high parathyroid levels and IGF-1 was low in 52%. Mean serum ferritin level was 5344 ± 2855 ng/dl. There was statistical significance (p = 0.046) between chronological age and BMD. All 42 cases were divided into two groups: Group-1 (Normal DEXA), Group-2 (Abnormal DEXA) and analysis of biochemical indices between two groups showed no significant difference in any of the biochemical parameters.
  
  
  CONCLUSIONS
  This study revealed majority of thalassemics with inadequate chelation have bone resorption with advancing chronological age and BMD should be evaluated regularly for early diagnosis to prevent morbidity.
authors.affiliation: Department of Pediatrics, Dr Balabhai Nanavati hospital Mumbai, 501, Rangmahal 5th floor, 2 Mount Mary road, Bandra (West), Mumbai 400050, India. deandoc2000@hotmail.com
authors.forename: Rashid
authors.initials: R
authors.lastname: Merchant
authors.forename: Amish
authors.initials: A
authors.lastname: Udani
authors.forename: Vipla
authors.initials: V
authors.lastname: Puri
authors.forename: Valentina
authors.initials: V
authors.lastname: D'cruz
authors.forename: Deepak
authors.initials: D
authors.lastname: Patkar
authors.forename: Aarti
authors.initials: A
authors.lastname: Karkera
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D001803:Blood Transfusion / Q000379:methods; D015519:Bone Density / Q000502:physiology; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D015675:Osteocalcin / Q000032:analysis; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000032:analysis; D011446:Prospective Studies; D011863:Radioimmunoassay; D018570:Risk Assessment; D017678:Sex Distribution; D013789:Thalassemia / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D014807:Vitamin D / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D015675:Osteocalcin; D014807:Vitamin D