Prevalence of Bone Density Reduction and Its Related Factors in Hemophilia Patients in South Khorasan Province in 2018

Abstract

Background: 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]

Bone mineral density in haemophilia patients: A systematic review and meta‐analysis

“…However, a recent study came up with the opposite effect. Here, Alireza Ehsanbakhsh 17 showed that lean patients had the highest relative frequency of BMD reduction, and overweight patients had no BMD reduction, the difference being statistically significant, which is inconsistent with the results of this study. This difference may be related to the age of the subjects studied.…”

“…Finally, according to the subjective judgement of bias risk and research quality, two of the included studies were of high quality 16,19 . NIne were of medium quality 1,17,20–26 . One was of low quality 18 ; we adjusted the studies with higher bias, the most common being age, haemophilia type, ethnicity, body mass index and number of joint diseases.…”

“…This difference may be related to the age of the subjects studied. The topics explored by Alioglu 26 and Chris Barnes 22 were all children, with an average age of 9; Alireza Ehsanbakhsh 17 included adults, with an average age of 34. The subgroup analysis of this study also showed that children had lower BMD than adults.…”

“…16,19 NIne were of medium quality. 1,17,[20][21][22][23][24][25][26] One was of low quality 18 ; we adjusted the studies with higher bias, the most common being age, haemophilia type, ethnicity, body mass index and number of joint diseases. For the quality of each study, we assessed case-control studies using the NOS, see Supplementary Table 3.…”

Risk of low bone mineral density in patients with haemophilia: a systematic review and meta-analysis

“…All eligible studies were published in English. Of these included studies, 13 reported prevalence of low BMD as an outcome [ 21 – 23 , 26 – 35 ], and 16 reported changes in BMD as an outcome [ 17 – 22 , 24 – 28 , 30 , 31 , 33 – 35 ]. 16 studies [ 17 – 22 , 24 – 28 , 30 , 31 , 33 – 35 ] examined BMD of lumbar spine (LS), 6 [ 20 , 22 , 24 , 26 , 27 , 31 ] examined BMD of femoral neck (FN), and 6 [ 19 , 26 , 27 , 31 , 33 , 35 ] examined BMD of total hip (TH).…”