Prevalence of Bone Density Reduction and Its Related Factors in Hemophilia Patients in South Khorasan Province in 2018
AbstractBackground: The present study aimed to determine the prevalence of bone density reduction and its associated factors in hemophilia patients in South Khorasan Province in 2018. Materials and Methods: This case-control study was conducted on all patients with hemophilia type A with medical records in Hemophilia center in South Khorasan province. A number of 57 eligible subjects who met the criteria were selected based on census method. Thereafter, 60 non-hemophilic individuals who were similar to hemophilic patients in terms of age and body mass index were selected by convenience sampling method. DXA device was used to measure bone mineral density (BMD) in two locations of femoral neck and lumbar vertebrae. Data were analyzed in SPSS software (version 19), using Chi-square, Fisher’s exact test, and independent t-test. A P-value less than 0.05 was considered statistically significant. Results: The prevalence rate of bone density reduction in spine bone in hemophilia patients was measured at 31.6% and 13.3% in non-hemophilia subjects (P=0.02); moreover, this rate in hip bone was reported as 7% and 5%, respectively (P=0.65). Relative frequency of bone density reduction in the spine and hip bone was not significantly different among hemophilia patients based on age, severity of hemophilia, vitamin D, hepatitis and smoking (P>0.05). However, a significant difference was detected in terms of body mass index (P<0.05). Conclusion: Based on the obtained results, the prevalence of bone density reduction in hemophilic patients was significantly higher, as compared to that of non-hemophilia patients. This necessitates the implementation of drastic preventive measures, prompt diagnosis, timely treatment, and appropriate therapeutic measures. [GMJ.2020;9:e1711]
Behrman R, Kligman R, Janson H. Nelson text book of pediatrics. 18th ed. Philadelphia: Saunders 2008; 1657-60.
Owaidah T, Al Momen A, Alzahrani H, Almusa A, Alkasim F, Tarawah A, et al. The prevalence of factor VIII and IX inhibitors among Saudi patients with hemophilia, Results from the Saudi national hemophilia screening program. Medicine (Baltimore). 2017; 96(2):e5456.
Falk B, Portal S, Tiktinsky R, Zigel L, Weinstein Y, Constantini N, et al. Bone properties and muscle strength of young haemophilia patients. Haemophilia. 2005; 11(4):380-6.
Dorgalaleh A, Dadashizadeh G, Bamedi T. Hemophilia in Iran. Hematology. 2016; 21(5):300-10.
Roushan N, Meysamie A, Managhchi M, Esmaili J, Dormohammadi T. Bone Mineral Density in Hemophilia Patients. Indian J Hematol Blood Transfus. 2014; 30(4):351-5.
WHO. Prevention and Management of Osteoporosis: Report ofa WHO Scientific Group. Geneva: World Health Organization; 2003:1-120.
Raisz LG, Shoukri KG. Pathogenesis of osteoporosis. In: Mundy GR, Martin TJ. Pharmacology of bone. New York: Springer-Verlag; 1993. P. 299-323.
Stein E, Shane E. Secondary osteoporosis. Endocrinol Metab Clin North Am. 2003; 32:115-34.
Origa R, Fiumana E, Gamberini MR, Armari S, Mottes M, Sangalli A, et al. Osteoporosis in betathalassemia: Clinical and genetic aspects. Ann New York Acad Scie. 2005; 1054:451-6.
Lewiecki EM, Watts NB, McClung MR, Petak SM, Bachrach LK, Shepherd JA, et al. Official positions of the International Society for Clinical Densitometry. J Clin Endocrinol Metab. 2004; 89(8):3651-5.
Gurevitch O, Slavin S. The hematological etiology of osteoporosis. Med Hypotheses. 2006; 67(4):729-35.
Kaufman JM, Reginster JY, Boonen S, Brandi ML, Cooper C, Dere W, et al. Treatment of osteoporosis in men. Bone. 2013; 53(1):134-44.
Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Pasco JA. Socioeconomic status and bone mineral density in a pop¬ulation-based sample of men. Bone. 2010; 46(4):993-9.
Guthrie JR, Ebeling PR, Dennerstein L, Wark JD. Riskfactors for osteoporosis: Prevalence, change and associationwith bone density. Medscape Womens Health. 2000; 5(5):2-7.
Anagnostis P, Vakalopoulou S, Slavakis A, Charizopoulou M, Kazantzidou E, Chrysopoulou T, et al. Reduced bone mineral density in patients with haemophilia A and B in Northern Greece. Thromb Haemost. 2012; 107(3):545-51.
Nair AP, Jijina F, Ghosh K, Madkaikar M, Shrikhande M, Nema M. Osteoporosis in young haemophiliacs from western India. Am J Hematol. 2007;82(6):453-7.
Christoforidis A, Economou M, Papadopoulou E, Kazantzidou E, Gompakis N, Athanassiou-Metaxa M. Bone status of children with hemophilia A assessed with quantitative ultrasound sonography (QUS) and dual energy X-ray absorptiometry (DXA). J Pediatr Hematol Oncol. 2010; 32(7):e259-63.
Hoch AZ, Pajewski NM, Moraski L, Carrera GF, Wilson CR, Hoffmann RG, et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clin J Sport Med. 2009;19(5):421-8.
Gerstner G, Damiano ML, Tom A, Worman C, Schultz W, Recht M, et al. Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia. Hemophilia. 2009; 15(2):559-65.
Kiper Unal HD, Comert Ozkan M, Atilla FD, Demirci Z, Soyer N, Yildirim Simsir I, et al. Evaluation of bone mineral density and related parameters in patients with haemophilia: a single center cross-sectional study. Am J Blood Res. 2017;7(5):59-66.
Naderi A, Nikvarz M, Arasteh M, Shokoohi M. Osteoporosis/ osteopenia and hemophilic arthropathy in severe hemophilic patients. Arch Iran Med. 2012; 15(2):82-4.
Bazrafshan HR, Qorbani M, ShadpourRashti H, Aghaei M, Safari R. Prevalence of osteoporosis and its association with demographic characterirstics -Gorgan, Iran. Hormozgan Med J. 2011; 15(1):56-62.
Ehsanbakhsh AR, Akhbari H, Bahri Iraee M, Sailanian Toosi F, Khorashadizadeh N, Rezvani MR,et al. The Prevalence of Undetected Vertebral Fracture in Patients with Back Pain by Dual-Energy X-ray Absorptiometry (DXA) of the Lateral Thoracic and Lumbar Spine. Asian Spine J. 2011; 5(3):139-45.
Omar Mostafa N, Adolf Habib S, El Adham EK. Evaluation of Bone Mineral Density in Egyptian Hemophilia A Children. Austral J Basic Appl Sci. 2011; 5(12):2812-16.
Kempton CL, Antun A, Antoniucci DM. Carpenter W, Ribeiro M, Stein S, et al. Bone density in haemophilia: a single institutional cross-sectional study. Haemophilia. 2014; 20(1):12240.
Abd EL Naeem RS, EL Sebaie EI Hefnawy H, Abd EL Naser Abd EL Aziz O, Mohamed Ezz EL Din EI Mikkawy D, Abdel Gawad Tantawy A, et al. Assessment of Bone Mineral Density and Functional status in Children with Hemophilic. Arthropathy. 2016; 5(1):035-41.
Eshghi P, Moradveisi B. Frequency of Decreased Bone Mineral Density and Its Risk Factors during Childhood among Iranian Hemophilia Patients. IJBC. 2012; 1:13-7.
Lorio A, Fabbriciani G, Marcucci M, Brozzetti M, Filipponi P. Bone mineral density in haemophilia patients.A meta-analysis. Thromb Haemost. 2010; 103(3):596-603.
Sossa Melo CL, Wandurraga EA, Pena AM, Jimenez SI, Salazar LA, Ochoa ME,et al. Low bone mineral density and associated factors in patients with haemophilia in Colombia. Haemophilia. 2018; 24(4):e222-9.
Darby SC, Keeling DM, Spooner RJ, Wan Kan S, Giangrande PL, Collins PW, et al. The incidence of factor VIII and factor IX inhibitors in the hemophilia population of the UK and their effect on subsequent mortality, 1977-99. J Thromb Haemost. 2004; 2(7):1047-54.
Barnes C, Wong P, Egan B, Speller T, Cameron F, Jones G, et al. Reduced bone density among children with severe hemophilia. Pediatrics. 2004; 114(2):e177-81.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).