Low bone mass due to sickle cell anemia: is it becoming a real issue?

BACKGROUND: The prevalence of sickle cell anemia in Saudi population was reported to be between 0-5.27%.

OBJECTIVE: This cross-sectional study was conducted to assess the prevalence of osteoporosis and osteopenia in patients with sickle cell anemia and to correlate its severity with the hematological parameters.

METHODS: A cross-sectional study which included consecutive adult patients with sickle cell anemia attending the outpatient clinics or were admitted with uncomplicated vaso-occlusive crisis to King Fahd University Hospital, Al Khobar, Saudi Arabia, between August 2006 and March 2007 was undertaken. After informed verbal consent to participate, patient's age and sex were documented and body mass index (BMI) calculated. Blood was drawn for heamatological and biochemical parameters. Bone mineral density (BMD) measurement was done using dual energy X-ray absorbtiometry (DEXA) at upper femur and lumbar spine. Osteopenia and osteoporosis were diagnosed as per the WHO criteria.

RESULTS: A total of 87 patients were studied. There were 41 male and 46 female patients. The mean age of males was 29.59+/-6.1 years, and females was 32.1+/-7.6 years. Over 65% of the males and 65.2% of the females were either osteopenic or osteoporotic. The prevalence of osteoporosis in both groups was highest at lumbar spine. Other variables like BMI, percentage of sickle hemoglobin and degree of anemia did not affect the bone mass.

CONCLUSIONS: This study supports the view that prevalence of osteopenia and osteoporosis among sickle cell anemia patients is high. Sickle cell anemia is becoming the most common cause of secondary osteoporosis and physician's awareness about this issue is essential for early diagnosis and appropriate management.