Osteoporosis in children and adolescents with transfusion-dependent thalassemia and the diagnostic value of different indicators

BACKGROUND: The study aimed to investigate the prevalence of osteoporosis in children and adolescents with transfusion-dependent thalassemia (TDT) and evaluate the diagnostic value of different osteoporosis indicators. METHODS: Clinical data were collected from children and adolescents with TDT treated with blood transfusion between March 2022 and January 2024 at Huizhou Central People's Hospital and Huizhou First Hospital. The patients were grouped according to the presence of osteoporosis (International Society for Clinical Densitometry [ISCD] criteria). RESULTS: Of 138 patients included in the study, 48 (34.8%) had osteoporosis. The patients with osteoporosis mainly had asymptomatic grade I fractures of the spine. Using the dual-X-ray absorptiometry (DXA) standards from the World Health Organization, height-corrected TBLH Z-score ≤-2 was associated with osteoporosis (30.4% vs. 14.9%, P = 0.035), displaying 30.4% sensitivity and 85.1% specificity. According to the Chinese DXA standards, height-corrected and age-specific Z-scores ≤-2 were not associated with osteoporosis. CONCLUSION: The prevalence of osteoporosis among children and adolescents with TDT was 34.8%, indicating the need for screening for osteoporosis in that population. In TDT, the diagnosis of osteoporosis requires early detection of spinal fractures because bone density assessed by DXA is of limited value.