title: Low bone mass density is associated with hemolysis in Brazilian patients with sickle cell disease.
abstract: OBJECTIVE
  To determine whether kidney disease and hemolysis are associated with bone mass density in a population of adult Brazilian patients with sickle cell disease.
  
  
  BACKGROUND
  Bone involvement is a frequent clinical manifestation of sickle cell disease, and it has multiple causes; however, there are few consistent clinical associations between bone involvement and sickle cell disease.
  
  
  METHODS
  Patients over 20 years of age with sickle cell disease who were regularly followed at the Hematology and Hemotherapy Center of Campinas, Brazil, were sorted into three groups, including those with normal bone mass density, those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared using statistical analyses.
  
  
  RESULTS
  In total, 65 patients were included in this study: 12 (18.5%) with normal bone mass density, 37 (57%) with osteopenia and 16 (24.5%) with osteoporosis. Overall, 53 patients (81.5%) had bone mass densities below normal standards. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p<0.05). Osteoporosis patients also had decreased hemoglobin levels (p<0.05). Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance, or microalbuminuria.
  
  
  CONCLUSIONS
  A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased reticulocyte counts and low hemoglobin levels.
authors.affiliation: Hematology and Hemotherapy Center/Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas-UNICAMP, Campinas, SP, Brazil.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Baldanzi
authors.forename: Fabiola
authors.initials: F
authors.lastname: Traina
authors.forename: João Francisco
authors.initials: JF
authors.lastname: Marques Neto
authors.forename: Allan Oliveira
authors.initials: AO
authors.lastname: Santos
authors.forename: Celso Dario
authors.initials: CD
authors.lastname: Ramos
authors.forename: Sara T Olalla
authors.initials: ST
authors.lastname: Saad
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D015519:Bone Density / Q000502:physiology*; D001851:Bone Diseases, Metabolic / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000503:physiopathology; D017701:Reticulocyte Count; D055815:Young Adult
chemical_list: D007770:L-Lactate Dehydrogenase