Usefulness of bone microarchitectural and geometric DXA‐derived parameters in haemophilic patients

Abstract

Introduction Haemophilia is a recessive X‐linked inherited bleeding disorder, whose typical symptom is spontaneous intra‐articular haemorrhage leading to joint damage, which can be quantified by the Haemophilia Joint Health Score (HJHS). Arthropathy and other characteristics of haemophilic patients may reduce bone mineral density (BMD), increasing the risk for fragility fractures, which also may occur due to bone quality impairment. Aim To evaluate bone quantity by BMD and bone quality by Trabecular Bone Score (TBS), bone strain (BS) and hip structural analysis (HSA) in a haemophilic population, and to relate these parameters to general and specific risk factors for osteoporosis and to HJHS. Methods Seventy haemophilic patients ≥18 years were enrolled. Densitometric derived lumbar spine and femoral BMD with TBS, BS and HSA were performed. Data regarding risk factors for osteoporosis, presence of arthroprosthesis or arthrodesis were collected, and HJHS was calculated. A Z‐score ≤−2.0 defined a low bone mass. Results Overall, a reduced bone mass was present in 52 patients at the femur and in 38 at the lumbar spine. Lumbar spine BMD, TBS and BS did not correlate with HJHS. HSA bone geometric parameters correlated negatively with HJHS. BMD and HSA correlated with some risk factors for osteoporosis, namely HIV and its therapy, hepatitis C and smoking. Conclusions Haemophilic patients showed a reduced BMD at lumbar spine and/or femur. Femoral bone density and geometry correlated with HJHS. The microarchitecture of the trabecular vertebral bone seemed to be not influenced by the haemophilic joint damage.

Bone strain index reproducibility and soft tissue thickness influence: a dual x-ray photon absorptiometry phantom study

“…Thus, high BSI values are associated with lower BMD values [10]. Finally, in recent clinical studies, BSI appeared to be useful to identify the osteoporotic patients’ subgroup particularly prone to fragility fractures [13], and to characterise young patients affected by secondary osteoporosis [14, 15].…”

The Bone Microarchitecture Deficit in Patients with Hemophilia Is Influenced by Arthropathy, Hepatitis C Infection, and Physical Activity

“…22 In some studies, an even higher prevalence up to 74.0% has been observed, e.g., in Turkish children 23 or Italian adults (95.7%). 4 Evaluation of vBMD at the distal radius and tibia generally showed strong correlations to DXA Z-score. However, with adding the HR-pQCT analysis, also patients with normal Z-scores sometimes showed alterations in BMD and bone microarchitecture, and more detailed information on bone alterations (i.e., trabecular and cortical structure and BMD) could be obtained, enabling detailed analyses of potential contributing risk factors.…”

PHILEOS (haemoPHILia and ostEoporOSis) Study: protocol of a multicentre prospective case–control study

“…5 Although both meta-analyses showed an association between haemophilia and BMD decrease, the haemophilia type, severity and presence or not of prophylactic antihaemophilic treatment in patients with bone loss was often not reported. [6][7][8][9][10][11] Furthermore, the case-control studies included in these meta-analyses compared the mean BMD values between patients and controls, but they did not evaluate osteoporosis prevalence in function of the haemophilia type and severity.…”