1. Insufficiency fractures and asymptomatic vertebral fractures in adult patients with Beta-Thalassaemia Major
M.R. Gamberini, M. Fortini, N. Murri Dello Diago*, M. Totaro*, C. Zagà*
Day Hospital Thalassaemia and Haemoglobinopathies – Department of Growth and Reproduction, Azienda Ospedaliero-Universitaria - Ferrara, Italy
* Radiology University - Department of Diagnostic Imaging and Medical Laboratory, Azienda Ospedaliero-Universitaria - Ferrara, Italy
Introduction: Despite regular transfusions and iron chelation therapy, osteopenia and osteoporosis are common complications in patients with ß-Thalassaemia Major (TM) and fractures are reported up to 55% of cases (1,2). Recently, unrecognized vertebral fractures (VF) in adolescents and young adults with thalassaemia syndromes are reported in 13% of cases (3).
Objectives: Evaluate prevalence of fractures, insufficiency fractures (IF) and asymptomatic VF in adult patients with thalassaemia.
Patients and Methods
One-hundred and twenty-two Caucasian patients (60 females, 62 males; mean age: 38.1±6yrs, range: 20–53) affected by TM were enrolled in this study. Fracture history (age, site, cause of fracture and type of treatment) was collected by questionnaire interview and review of medical records. Fracture was classified as insufficiency when due to non-adequate or mild trauma. In 43 (19F, 24M) patients with low vertebral bone mineral density (T-score <-2,5 by dual X-ray photon absorptiometry, Hologic Bone Densitometer), the presence and the severity of VF were assessed by morphometric X-ray according to the semi-quantitative method described by Genant (4).
Results:
Prevalence of fractures by history : 59,5%, no significant difference in gender.
Insufficiency fractures :
54 events in 27 (22%) patients (19F, 8M, p<0.05)
IF were more frequent (38 vs. 16 events, p=0,035) and early in age (32,3±9,6 vs. 41,9 ±4,7 yrs, p= 0,007) in female than in male patients
3. Vertebral fractures by spine morphometric X-ray :
19/43 (44,2%) patients, no significant difference by sex
≥ 2 vertebral bodies: 10/19 (53%) cases
Genant compression deformity:
grade 1: 85% ; grade 2: 5%; grade 3: 5%
Location: D12 (20%), D11 (15%), L1 (12,5%), L2 (12,5%).
Spine X-ray in a 41 yrs old female patient:
D7, grade 2
D8, grade 1
D9 grade 1
Conclusions: Insufficiency fractures reported by clinical history and vertebral fractures by X-ray were found very common in adult patients with TM, mainly related to low bone mineral density.
References: 1) Vogiatzi, Prevalence of fractures among the Thalassemia syndromes in North America, Bone 2006, 38: 571–5; 2)Haidar, The Spine in β -Thalassemia Syndromes, Spine 2012, 37:334–9; 3)Engkakul, Unrecognized vertebral fractures in adolescents and young adults with thalassemia syndromes, J Pediatr Hematol Oncol. 2013, 35:2012-7; 4) Genant, Vertebral fracture assessment using a semiquantitative technique ,J Bone Min Res 1993,8: