SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.
Although the exact cause of the association remains unclear, “iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology.
Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.
The investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had been transfused or were currently on a transfusion program. They also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah of the department of hematology at Whittington Hospital NHS Trust, London.
Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two osteoporotic, two osteopenic).
Liver iron concentrations were higher among osteopenic females than their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.
Among males, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.
Overall, 47% of the study participants had osteopenia, Dr. Shah said.