pp 1–14 | Cite as

Dual-energy X-ray absorptiometry pitfalls in Thalassemia Major

  • Fabio Pellegrino
  • Maria Chiara Zatelli
  • Marta Bondanelli
  • Aldo Carnevale
  • Corrado Cittanti
  • Monica Fortini
  • Maria Rita Gamberini
  • Melchiore Giganti
  • Maria Rosaria AmbrosioEmail author



Low mineral mass and reduced bone strength with increased fracture risk are the main causes of morbidity in Thalassemia Major (TM). The pathogenesis is multifactorial and includes ineffective erythropoiesis with medullary expansion, multiple endocrine dysfunctions, direct iron bone deposition, deferoxamine-induced bone dysplasia, and reduced physical activity associated with disease complications. Dual-energy X-ray absorptiometry (DXA) is the “gold standard” for bone mineral density (BMD) assessment and for bone strength and quality evaluation. This method identifies patients at greater risk of fragility fractures, guiding treatment and monitoring response to therapy. In TM, DXA shows limitations concerning BMD calculation accuracy and fracture risk prediction. One of the main challenges in the assessment of bone health in patients with TM is the accurate interpretation of densitometric results.


This review investigates the major pitfalls in DXA implementation and interpretation in TM.


Available literature has been assessed.


DXA shows limitations in assessing bone mineral “status” in TM, especially in the paediatric population, due to the peculiar characteristics of bone architecture and deformities associated with the disease. A radiological technique adjustment in this population is mandatory.


DXA Thalassemia Osteoporosis BMD Fractures Limits 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants whose radiological images were included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Fabio Pellegrino
    • 1
  • Maria Chiara Zatelli
    • 2
  • Marta Bondanelli
    • 2
  • Aldo Carnevale
    • 1
  • Corrado Cittanti
    • 3
  • Monica Fortini
    • 4
  • Maria Rita Gamberini
    • 4
  • Melchiore Giganti
    • 1
  • Maria Rosaria Ambrosio
    • 2
    Email author
  1. 1.Department of Morphology, Surgery and Experimental Medicine, Section of RadiologyUniversity of FerraraFerraraItaly
  2. 2.Department of Medical Sciences, Section of Endocrinology and Internal MedicineUniversity of FerraraFerraraItaly
  3. 3.Department of Morphology, Surgery and Experimental MedicineUniversity of FerraraFerraraItaly
  4. 4.Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of MedicineAzienda Ospedaliero Universitaria S. AnnaCona – FerraraItaly

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