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Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia
Author(s) -
GERSTNER G.,
DAMIANO M. L.,
TOM A.,
WORMAN C.,
SCHULTZ W.,
RECHT M.,
STOPECK A. T.
Publication year - 2009
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/j.1365-2516.2008.01963.x
Subject(s) - medicine , osteopenia , bone mineral , haemophilia , osteoporosis , femoral neck , haemophilia a , bone density , population , body mass index , family history , physical therapy , pediatrics , environmental health
Summary. Osteoporosis in adult males is an under‐recognized problem. Patients with haemophilia have several predisposing factors for developing decreased bone mineral density (BMD) including prolonged periods of immobility, reduced weight bearing and co‐morbidities associated with bone loss. To establish prevalence and risk factors associated with decreased BMD in patients with haemophilia. Adults with moderate or severe haemophilia A or B underwent dual‐energy X‐ray absorptiometry (DXA). BMD was correlated to laboratory values, joint mobility measurements and physical activity questionnaires. Thirty patients completed evaluations. The median age was 41.5 years (range 18–61). Median lowest T‐score by DXA was −1.7 (range: −5.8 to +0.6), with the femoral neck being the site of the lowest T‐scores. Based on World Health Organization criteria, 70% of patients had decreased BMD. Twenty‐seven per cent of the participants ( n = 8) had osteoporosis and 43% ( n = 13) had osteopenia. Variables associated with increased bone loss included lower serum 25‐hydroxyvitamin D levels ( P = 0.03), lower body mass index ( P = 0.047), lower activity scores ( P = 0.02), decreased joint range of motion ( P = 0.046), HIV ( P = 0.03), HCV ( P = 0.02), history of inhibitor ( P = 0.01) and age ( P = 0.03). Adults with haemophilia are at increased risk for developing osteoporosis. A history of HCV and HIV infections, decreased joint range‐of‐motion, decreased activity levels, history of an inhibitor and low body weight predict bone loss and suggest a population to target for screening. A high prevalence of vitamin D insufficiency was observed. Future studies should investigate interventions, including vitamin D supplementation, to prevent bone loss and fractures for this at‐risk population.