In the journal Indian Pediatrics, researchers have reported a high prevalence of asymptomatic vertebral compression fractures and osteoporosis among adolescents and young adults with transfusion-dependent thalassemia (TDT).

The study at the Kasturba Medical College, Karnataka, India, prospectively evaluated metabolic bone disease and endocrinopathies in a cohort of patients with TDT (>5 years of age).

All patients received regular blood transfusion and underwent comprehensive endocrine and metabolic bone disease evaluation, including screening for short stature, delayed puberty, diabetes mellitus, hypothyroidism, adrenal insufficiency and hypoparathyroidism, and those older than 10 years of age also underwent X-ray of thoracolumbar spine, and dual energy X-ray absorptiometry (DXA) scanning.

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A total of 37 patients (male, 51%; female, 49%) with a mean age of 15 years were included in the study. The researchers reported that hypogonadism was the most common endocrine deficiency (62%), followed by short stature (32%), abnormal glucose metabolism (27%), subclinical adrenal insufficiency (25%), hypothyroidism (13%), and hypoparathyroidism (2%). The team also reported vitamin D insufficiency/deficiency in 60% of patients and hypocalcemia in 5.4% patients.

The researchers observed low bone mass and osteoporosis, indicated by vertebral fractures, in 21.6% and 10.8% of patients, respectively. Among the patients with vertebral fracture (n=4), all had hypogonadism and multiple endocrine deficiencies, and 3 were ≤18 years of age.

“The high and early occurrence of asymptomatic vertebral fractures in TDT underlines the need for early screening for vertebral fractures with at least spine x-rays,” the researchers concluded. “The finding of vertebral fractures being usually associated with hypogonadism and other endocrine deficiencies emphasizes the urgent need for greater awareness and timely preventive strategies.”

The primary limitation of the study was a lack of details about patients’ dietary intake.


Handattu K, Aroor S, Kini P, et al. Metabolic bone disease in children with transfusion-dependent thalassemia. Indian Pediatr. Published online August 26, 2022.