title: Bone density in transfusion dependent thalassemia patients in Urmia, Iran.
abstract: BACKGROUND
  Patients with thalassemia major and intermedia are susceptible to osteopenia and osteoporosis. The mechanism of osteoporosis in these patients is multifactorial. Transfusion related iron overload in endocrine organs leads to impaired growth hormone secretion, diabetes mellitus, hypothyroidism, hypoparathyroidism, lack of sex steroids and vitamin D deficiency that contribute to impairment in achieving an adequate bone mass .The aim of this study was assessment of frequency of bone loss in patients with thalassemia major and intermedia in Urmia City of West Azerbaijan, Iran.
  
  
  METHODS
  In this cross sectional descriptive study,10 patients (lower than 18 y/o)with transfusion dependent thalassemia attending to Motahari and Emam Khomeini hospitals in Urmia city of Iran were enrolled and scanned for Bone Mineral Density (BMD) starting at around 10 years old.
  
  
  RESULTS
  Tenatients (6 male and 4 female) with transfusion dependent thalassemia (β-thalassemia major and intermedia) aged 13to 17 years in Urmia city of Iran were enrolled. Mean age of patients was 15.1±.37year old. Among them, 8 patients (80%)had low BMD and2 of them (20%) had normal BMD in lumbar spine. Only 30% of patients had low BMD in the neck of femur.
  
  
  CONCLUSIONS
  We should perform annual BMD in patients with thalassemia major and intermedia and hemoglobin H disease in age of higher than 8 year old and treat low BMD with administration of bisphosphonate, calcium and vitamin D supplements. Medical consultation with a rheumatologist and /or an endocrinologist should be performed in these patients. Changing lifestyle with mild daily exercise, adequate calcium containing foods, avoiding heavy activities, stop smoking, iron chelation therapy in adequate dosage, early diagnosis and treatment of endocrine insufficiency and regular blood transfusions can help to achieve an optimal bone density in these patients.
authors.affiliation: Assistant professor of Hematology/Medical Oncology, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: N
authors.initials: N
authors.lastname: Valizadeh
authors.affiliation: Medical Student, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: F
authors.initials: F
authors.lastname: Farrokhi
authors.affiliation: MSc. of Biostatistics, Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: V
authors.initials: V
authors.lastname: Alinejad
authors.affiliation: Assistant professor of Rheumatology, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Sm
authors.initials: S
authors.lastname: Said Mardani
authors.affiliation: Assistant professor of Endocrinology and Metabolism, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: N
authors.initials: N
authors.lastname: Valizadeh
authors.affiliation: Assistant professor of Pediatric Hematology/Medical Oncology, Department of pediatric hematology, Motahari hospital, Urmia university of medical sciences, Urmia , Iran.
authors.forename: S
authors.initials: S
authors.lastname: Hejazi
authors.affiliation: Assistant professor of Pediatric Hematology/Medical Oncology, Department of pediatric hematology, Motahari hospital, Urmia University of medical sciences, Urmia, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Noroozi
keywords: Bone Loss; Bone mineral density; Osteoporosis; Thalassemia