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Dual-energy X-ray absorptiometry pitfalls in Thalassemia Major

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Abstract

Background

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.

Purpose

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

Methods

Available literature has been assessed.

Conclusions

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.

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Authors and Affiliations

  1. Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy

    Fabio Pellegrino, Aldo Carnevale & Melchiore Giganti

  2. Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy

    Maria Chiara Zatelli, Marta Bondanelli & Maria Rosaria Ambrosio

  3. Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy

    Corrado Cittanti

  4. Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona – Ferrara, Italy

    Monica Fortini & Maria Rita Gamberini

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  1. Fabio Pellegrino
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Pellegrino, F., Zatelli, M.C., Bondanelli, M. et al. Dual-energy X-ray absorptiometry pitfalls in Thalassemia Major. Endocrine 65, 469–482 (2019). https://doi.org/10.1007/s12020-019-02003-x

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