Health-related quality of life, bone mineral density, and trabecular bone score of children with B-thalassemia major after bone marrow transplantation

Abstract: BACKGROUND: For children with serious hematologic, oncologic, and metabolic disorders, hematopoietic stem cell transplantation has significantly improved survival rates. Bone strength and fracture risk are indicated by bone mineral density (BMD), which quantifies the mineral content in bone tissue. Trabecular bone score (TBS) evaluates the microarchitecture and quality of bones. OBJECTIVES: This study aimed to assess health-related quality of life (HRQoL) in children who received bone marrow transplantation (BMT) for beta-thalassemia major (β-TM) in a single center Kurdistan Region of Iraq. MATERIALS AND METHODS: This retrospective cross-sectional study was carried out among 46 children previously diagnosed with β-TM who were receiving chelation therapy. Children who had previously had BMT were followed retrospectively to evaluate their outcomes. The BMD and TBS were used to measure the bone strength and fracture risk in children. RESULTS: The mean age of the children was 15.02 (Range: 7–18 year), who underwent BMT at a mean age of 6.83 years. Boys comprised 52.17% of participants. HRQoL scores (out of 100%) were: total HRQoL (71.0%), physical (69.2%), emotional (61.3%), social (82.1%), and school (73.4%). Most had acceptable HRQoL (89.13%), especially in social functioning (95.65%). No gender differences were found in HRQoL or BMD, but boys had higher TBS than girls (1.46 vs. 1.34; P = 0.0003). BMD and TBS were within normal ranges. BMD was significantly higher in patients followed 6–15 years versus 1–5 years ( P = 0.000). No significant correlations were found between BMD or TBS and HRQoL domains. CONCLUSIONS: Children with β-TM who underwent BMT demonstrated overall good HRQoL and preserved bone health, with stable outcomes across follow-up periods. Emotional functioning remained the most affected domain, underscoring the importance of ongoing psychosocial support alongside routine clinical care.