Bone mineral density in haemophilia patients

Alfonso Iorio; Gianluigi Fabbriciani; Maura Marcucci; Matteo Brozzetti; Paolo Filipponi

doi:10.1160/TH09-09-0629

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 103(03): 596-603
DOI: 10.1160/TH09-09-0629

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Bone mineral density in haemophilia patients

A meta-analysis

Authors

Alfonso Iorio

¹Hemophilia Centre – Internal and Vascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
Gianluigi Fabbriciani

²U.O. Medicina Generale, Azienda A.S.L. n. 1 dell’Umbria – Città di Castello and Umbertide, Italy

³Institute of Internal Medicine, Angiology and Arteriosclerosis, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
Maura Marcucci

¹Hemophilia Centre – Internal and Vascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
Matteo Brozzetti

⁴Ospedale di Norcia, Azienda A.S.L. n. 2 dell’Umbria, Perugia, Italy
Paolo Filipponi

²U.O. Medicina Generale, Azienda A.S.L. n. 1 dell’Umbria – Città di Castello and Umbertide, Italy

Abstract

Summary

Osteoporosis is caused by bone mineral density (BMD) reduction. Haemophilia patients are at increased risk of osteoporosis because of decreased physical activity and blood-borne virus infections. This systematic review of the literature aims at evaluating BMD reduction in severe haemophilia patients and its correlation with patients’ characteristics. Seven case-control studies evaluating lumbar BMD values [g/cm²] (all studies), BMI (5/7 studies), and hepatitis C virus (HCV) seropositivity (6/7 studies) in severe haemophilia patients and controls were meta-analysed. Standardised mean difference (SMD) of BMD was used to compare cases and controls. The effect of body mass index (BMI) and HCV infection was investigated by meta-regression. One hundred one adult cases (age 33 ± 8.9) with 101 controls and 111 paediatric cases (age 8 ± 3.6) with 307 controls were available for analysis. Lumbar BMD was significantly lower in severe haemophilia patients than in controls, both in adult (pooled SMD –1.379, 95% confidence interval [CI] –2.355 to –0.403, p=0.006) and children (pooled SMD –0.438, 95% CI –0.686 to –0.189, p=0.001). The reduction in BMD in patients versus controls was not significantly correlated with the reduction in BMI or with the percentage of HCV-infected patients. This meta-analysis confirms the association between severe haemophilia and low BMD. Future studies should investigate fracture rates and interventions to prevent bone loss in persons with haemophilia

Keywords

Bone mineral density - osteoporosis - haemophilia - HCV infection

Full Text

References

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