Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia
Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia
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DOI：
10.1111/j.1365-2516.2008.01963.x
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发表时间：
2009-03-01
期刊：
影响因子：
3.9
通讯作者：
Stopeck, A. T.
中科院分区：
文献类型：
--
作者：
Gerstner, G.;Damiano, M. L.;Stopeck, A. T.
成年男性骨质疏松症是一个未被充分认识的问题。血友病患者有几个诱发骨密度下降的因素，包括长时间不活动、体重减轻和与骨质流失相关的合并症。建立血友病患者骨密度降低的患病率和危险因素。患有中度或重度血友病A或B的成年人接受双能x线吸收仪（DXA）。骨密度与实验室值、关节活动度测量和身体活动问卷相关。30例患者完成了评估。中位年龄为41.5岁（18-61岁）。DXA的最低t评分中位数为-1.7（范围：-5.8至+0.6），其中股骨颈是t评分最低的部位。根据世界卫生组织的标准，70%的患者骨密度下降。27%的参与者（n=8）患有骨质疏松症，43% （n=13）患有骨质减少症。与骨质流失增加相关的变量包括血清25-羟基维生素D水平降低（P=0.03）、体重指数降低（P=0.047）、活动度评分降低（P=0.02）、关节活动范围减小（P=0.046）、HIV （P=0.03）、HCV （P=0.02）、抑制剂史（P=0.01）和年龄（P=0.03）。患有血友病的成年人患骨质疏松症的风险增加。HCV和HIV感染史，关节活动范围减小，活动水平降低，抑制剂史和低体重可预测骨质流失，并提示筛查目标人群。观察到维生素D不足的高患病率。未来的研究应该调查干预措施，包括补充维生素D，以防止这一高危人群的骨质流失和骨折。
Osteoporosis in adult males is an under-recognized problem. Patients with haemophilia have several predisposing factors for developing decreased bone mineral density (BMD) including prolonged periods of immobility, reduced weight bearing and co-morbidities associated with bone loss. To establish prevalence and risk factors associated with decreased BMD in patients with haemophilia. Adults with moderate or severe haemophilia A or B underwent dual-energy X-ray absorptiometry (DXA). BMD was correlated to laboratory values, joint mobility measurements and physical activity questionnaires. Thirty patients completed evaluations. The median age was 41.5 years (range 18-61). Median lowest T-score by DXA was -1.7 (range: -5.8 to +0.6), with the femoral neck being the site of the lowest T-scores. Based on World Health Organization criteria, 70% of patients had decreased BMD. Twenty-seven per cent of the participants (n=8) had osteoporosis and 43% (n=13) had osteopenia. Variables associated with increased bone loss included lower serum 25-hydroxyvitamin D levels (P=0.03), lower body mass index (P=0.047), lower activity scores (P=0.02), decreased joint range of motion (P=0.046), HIV (P=0.03), HCV (P=0.02), history of inhibitor (P=0.01) and age (P=0.03). Adults with haemophilia are at increased risk for developing osteoporosis. A history of HCV and HIV infections, decreased joint range-of-motion, decreased activity levels, history of an inhibitor and low body weight predict bone loss and suggest a population to target for screening. A high prevalence of vitamin D insufficiency was observed. Future studies should investigate interventions, including vitamin D supplementation, to prevent bone loss and fractures for this at-risk population.