Use of novel bone turnover markers to assess bone health in children with transfusion dependent thalassemia and its correlation with bone mineral density

Osteoporosis is a significant cause of morbidity with a prevalence of 12 % –60 % even in well-transfused patients of transfusion-dependent Thalassemia (TDT). 73 TDT patients and 32 age and gender-matched healthy controls of 5–10 years of age were included in the study. Bone mineral concentration and density (BMC and BMD) were estimated using dual energy X-ray absorptiometry (DEXA) in both groups. Biochemical bone markers (serum calcium, vitamin D, phosphate, PTH, sclerostin, osteocalcin, BALP, and C-telopeptide) were also assessed in both groups and correlated with BMC and BMD. Mean BMC and BMD at the lumbar spine in cases were found to be significantly lower as compared to controls (p value < 0.0001). The mean serum calcium, phosphate, Vitamin D and PTH levels were within the normal range and comparable in both groups. BALP, Sclerostin, and C-telopeptide levels were significantly higher in thalassemics (p < 0.05). Except for Osteoclacin, none of the bone markers were found to have a significant correlation with BMC and BMD. Children with TDT have poor bone health as compared to their healthy counterparts as documented by DEXA scan and bone turnover markers (BTM). BTM are more sensitive in monitoring the treatment response to osteoporosis. They could be used in clinical practice by having a better understanding of the biological and preanalytical variables and having access to fast, accurate, standardised, and affordable BTM assays.