Bone quality, vertebral fragility fractures and intervertebral disc calcifications in patients with transfusion-dependent beta-thalassemia

We aimed to characterize bone quality, bone strength, and to assess prevalence of vertebral fragility fractures and intervertebral disc calcifications (IDCs) in patients with transfusion-dependent beta-thalassemia, with bone mineral density (BMD) below or within the expected range for age. In this cross-sectional study, we included adults affected by transfusion-dependent beta-thalassemia, in chelation therapy, naive to anti-osteoporotic drugs or calcium and vitamin D supplementation. Primary outcomes were bone quality, assessed by trabecular bone score (TBS), and geometric parameters of the proximal femur, assessed by Hip Structural Analysis (HSA). Furthermore, the prevalence of vertebral fragility fractures andIDCs was also assessed.Forty-four patients (12 males, 32 females), mean aged 35.7 +/- 9.9 years, were divided into 2 groups: 23 with a BMD below the expected range for age (Zs <=-2) and 21 with a BMD within the expected range for age (Zs>-2). Patients with Zs <=-2 showed a significantly lower TBS than those with Zs>-2 (p=0.0017). Furthermore, patients with Zs <=-2 had significantly lower values in main HSA parameters.In our cohort of patients affected by transfusion-dependent beta-thalassemia, those with a BMD below the expected range for age had significantly lower bone quality and strength.