Efficacy Of Bisphosphonates, Vitamin D And Calcium Supplements In Transfusion Dependent Thalassemia Children With Low Bone Mineral Density – A One Year Hospital Based Interventional Study

Abstract

Efficacy of Bisphosphonates in the treatment of Thalassemia induced Low Bone Mineral Density - A One Year Hospital Based Interventional Study. Objectives To assess the efficacy of Tab Alendronate in improving bone mineral density in transfusion dependent β-thalassemia(TDT) children and the prevalence of low BMD in relation with duration of disease, height and serum ferritin. Methods This hospital based prospective interventional study done between Jan 2018 to Dec 2018.Total 42 cases of TDT between 8-18 years were selected after randomization . Demographic data including duration of disease, anthropometry, serum ferritin and calcium were recorded. Dual Energy X-ray Absorptiometry (DEXA) scan using Lunar prodigy paediatric software was done at lumbar spine (L1-L4) in 42 children, Of which 26 children had low BMD and treated with Tablet Alendronate 10 mg/ day , vitamin D, calcium for 6 months. DEXA scan was repeated after 6 months. Results Mean Z-scores of 42 patients was -1.15 + 1.49 S.D. The prevalence of low BMD was seen in 61.9% children. Mean Z-score significantly improved after 6 months of treatment (-2.18 + 0.83 S.D to -1.72 + 0.6, p value <0.0001). Low BMD was statistically significant with longer duration of disease( r = -0.5843, p value < 0.0001), short stature, low BMI and high ferritin levels. Conclusion Prevalence of low BMD was seen in 61.9% children. Treatment with Tab Alendronate is highly effective and safe in low BMD thalassemia children. Low BMD was associated with longer duration of disease, high ferritin levels and short stature. Annual BMD measurement is advised to prevent skeletal morbidity.