Risk factors of low bone mass in young patients with transfusiondependent beta-thalassemia

Wei Zhang^1,2Rongrong Liu³Siping He²Jihua huang²Liting Wu²Cuifeng Huang¹Yuzhen Liang^2*Yongrong Lai^3*

• ¹Guangxi Medical University, Nanning, China
• ²Department of Endocrinology, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
• ³Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Region, China

Objective To determine the prevalence of low bone mass and associated risk factors among children and adolescents suffering from transfusion-dependent beta-thalassemia (TDT). Methods In this study, a total of 389 children and adolescents with TDT (236 males and 153 females), treated between January 2015 and December 2024 in the Department of Hematology at the First Affiliated Hospital of Guangxi Medical University, were selected. Subjects were categorized into those with normal bone mass and those with low bone mass（LBM） based on bone mineral density assessments. Comparative analyses of various indicators between these two groups were performed.The overall prevalence of low bone mass in TDT patients aged 2-19 years without heightadjusted bone mineral density(BMD)correction was 31.6%, with a prevalence of 33.4% in the 5-19year subgroup. Multivariate analysis identified age (OR = 1.149, 95% CI 1.052-1.256, P < 0.05), IGF-1 levels < -2 SD (OR = 1.832, 95% CI 1.095-3.067, P < 0.05), and hypogonadism (OR = 2.990, 95% CI 1.087-8.229, P < 0.05) as independent risk factors for LBM. After applying heightadjusted BMD correction to the 5-19-year subgroup, the prevalence of low bone mass decreased to 15.8%. In this subgroup, multivariate analysis revealed age (OR = 1.137, 95% CI: 1.034-1.251, P < 0.05), normal BMI (OR = 0.383, 95% CI: 0.158-0.976, P < 0.05), and ALB levels (OR = 0.866, 95% CI: 0.783-0.953, P < 0.05) as independent predictors of LBM. This study reveals a high prevalence of LBM in children and adolescents with TDT. Without height-adjusted BMD correction, the overall prevalence was 31.6% (33.4% in the 5-19-year subgroup), which significantly decreased to 15.8% in the 5-19-year subgroup after height-adjusted correction, highlighting that traditional BMD assessments may overestimate risk due to unaccounted short stature. Multivariate analysis demonstrated that advancing age consistently remained an independent risk factor . The corrected model further identified normal BMI and ALB as protective factors, while IGF-1 levels < -2 SD and hypogonadism emerged as significant risks in the uncorrected model. Clinical management should prioritize height-adjusted BMD evaluation and integrated interventions targeting growth hormone axis function, gonadal status, and nutritional indicators to optimize bone health in TDT patients.