Relation between bone mineral density and serum ferritin levels in patients with thalassemia major

Background: Thalassemia/haemoglobinopathy is a hereditary disease with increased erythropoiesis and expansion of the bone marrow cavity. Consequently, there is a reduction in trabecular bone tissue resulting in osteopenia/osteoporosis. The present study was performed to determine bone mineral density (BMD) in children and adolescents with major thalassemia and its correlation with serum ferritin level. Methods: Seventy children and adolescents with major thalassemia were divided into two groups, (each group with 35 patients). Patients with serum ferritin level more than 1500 ng/dl were defined as case group and those with serum ferritin level lower than 1500 ng/dl were defined as control group. Thyroid and parathyroid function tests were performed as well as calcium and phosphorus serum level were checked. Dual X-ray Absorptiometry (DXA) was the diagnostic test for osteoporosis. Only patients with transfusion-dependent thalassemia major were enrolled. Patients with delayed puberty, hypothyroidism or parathyroid dysfunction, renal failure, liver failure, growth hormone deficiency and also those who used Calcitriol were excluded from the research. Results: Results showed that the mean serum ferritin in patients who had femoral osteoporosis was higher from those with osteopenia and normal density in the femur. (p=0.001). In addition, the mean serum ferritin in patients with vertebral osteoporosis was higher than that in those with osteopenia and normal bone density in the vertebral bones, (p=0.002). There is a significant difference between serum ferritin in different bone densities. Conclusions: Bone density is a good indicator of bone status in patients with major thalassemia and we recommend measuring it annually.