title: Unrecognized vertebral fractures in adolescents and young adults with thalassemia syndromes.
abstract: Osteoporosis is a common problem in thalassemics. As the most affected bone is spinal vertebrae, theoretically, it should have the greatest risk of fracture. However, vertebral fracture (VF) in thalassemics was rarely reported. Screening for asymptomatic VF in thalassemics has not been reported. We, therefore, evaluated prevalence of VF in adolescents and young adults with thalassemia. A total of 150 patients with thalassemia, aged 10 years and older were enrolled. Lateral thoracolumbar spine radiography was evaluated. Twenty patients (13%) had VF and 6 of 20 (30%) had multiple VFs. The 2 most common sites of VF were lumbar 1 and thoracic 12 vertebrae. Comparing with the group without VF, thalassemics with VF were older, had more severe degree of thalassemia, history of splenectomy and previous non-VF, more iron chelation use, and longer duration of blood transfusion, but had lower pretransfused hematocrit. Multivariate analysis revealed 2 predictive factors for VF, having severe thalassemia and aged 20 years or older (odds ratio 5.7 and 5.0, respectively). In conclusion, unrecognized asymptomatic VF in thalassemics was not uncommon. Risk factors associated with VF included severe thalassemia and age 20 years or older. Screening for VF in the high-risk patient should be considered.
authors.affiliation: Departments of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Pontipa
authors.initials: P
authors.lastname: Engkakul
authors.forename: Pat
authors.initials: P
authors.lastname: Mahachoklertwattana
authors.forename: Suphaneewan
authors.initials: S
authors.lastname: Jaovisidha
authors.forename: Ampaiwan
authors.initials: A
authors.lastname: Chuansumrit
authors.forename: Preamrudee
authors.initials: P
authors.lastname: Poomthavorn
authors.forename: Niyata
authors.initials: N
authors.lastname: Chitrapazt
authors.forename: Suporn
authors.initials: S
authors.lastname: Chuncharunee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013156:Splenectomy; D013577:Syndrome; D013785:Thailand / Q000453:epidemiology; D013789:Thalassemia / Q000150:complications* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D055815:Young Adult