P121: PREVALENCE OF VERTEBRAL COMPRESSION FRACTURE AND HYPOVITAMINOSIS D IN CHILDREN WITH THALASSEMIA MAJOR
Authors: L Rahmartani, T Sari, E Bermanshah, H Wulandari, P Wahidiyat
Journal: HemaSphere (2022)

Background: Thalassemia major has various complications that can increase morbidity and mortality. Osteoporosis is a common complication in thalassemia major and has a multifactorial pathogenesis. Osteoporosis can cause vertebral compression fractures and lead to disability. In TIF recommendation, a DEXA-scan is used to measure bone density in thalassemia patients. However, most patients in Indonesia could not afford the DEXA-scan examination because it is not covered by insurance. The 2019 ISCD Pediatric Positions Task Forces stated that the diagnosis of pediatric osteoporosis included the presence of a nontraumatic vertebral compression fracture (VF), without the need for BMD criteria. In Indonesia, there has been no study for the prevalence of hypovitaminosis D and vertebral compression fractures in children with thalassemia major and its correlation. Objective: To describe the prevalence of VF and hypovitaminosis D in children with thalassemia major. Methods: A cross-sectional study design was conducted in children with thalassemia major aged 7–18 years at the Thalassemia Center at Cipto Mangunkusumo National Hospital. Detection and evaluation techniques for vertebral fractures were using plain radiograph from Siemens Healthineers – Ysio Max – X-ray. The classification is based on Global Consensus Recommendations on Prevention and Management of Nutritional Rickets, whereas <30 nmol/L or <12 ng/mL are deficient, 30–50 nmol/L or 12–20 ng/mL are insufficient. Results: This study obtained 165 subjects (50,1% boys, 66% homozygous beta-thalassemia). Fifty-two subjects (31,5%) have VF, and three of them have both thoracal and lumbar fractures. The most common sites of VF were lumbar five and thoracic 11–12. The youngest subject who has VF is seven years old. Osteopenia was found in 67,3% of patients. There were no subjects with fractures who had complaints of pain or a history of previous trauma. Vitamin D levels [25(OH)D] were measured in 122 subjects, and hypovitaminosis D occurred in 77,9% of the subject (32,8% deficiency, 45,1% insufficiency). Our study found no significant relationship between vitamin D levels on the incidence of vertebral compression fractures (p>0,05). Conclusion: To our knowledge, this is the highest prevalence of VF among various studies that have been conducted. Vertebral X-ray is beneficial to detect bone density from osteopenia to fracture in children with thalassemia major. Hypovitaminosis D is common in thalassemia, requiring regular vitamin D administration. Further research is needed to consider the other contributing factors. References 1. Gaudio A, et al. J Clin Res Pediatr Endocrinol. 2019;11:110–7. 2. Steffey. Pediatric osteoporosis. Peds in Rev. 2019;40;259. 3. Piga A. Hematology Am Soc Hematol Educ Program. 2017(1):272–277. 4. Bishop N, et al. J Clin Densitom. 2014;17:275–80. 5. Munns CF, et al. J Clin Endocrinol Metab. 2016;101:394–415. 6. Soliman A, Det al. Mediterr J Hematol Infect Dis. 2013;5(1):e2013057. 7. Pulungan A, et al. Ann Pediatr Endocrinol Metab. 2021;26:92–8. 8. Vogiatzi MG, et al. J Bone Miner Res. 2009;24(3):543–557. 9. Dhale S, et al. J Med Sci Clin Res. 2009;07:254–7. 10. Agrawal A, et al. Pediatric Rev: Intl J Ped Res. 2016;9:652–6.