An In-Depth Analysis of Variable Dynamics Influencing Bone Mineral Density in Transfusion-Dependent Thalassemia Patients

Abstract

The survival of patients with transfusion-dependent thalassemia has increased with optimal blood transfusion. In adult patients with thalassemia, iron toxicity due to repeated blood transfusion is the main contributing factor causing decreased bone density and leads to mechanical disruption in the bone structure. This study aimed to analyze the variables affecting bone mineral density (BMD) in patients with thalassemia major. We enrolled patients with transfusion-dependent thalassemia who visited the Hasan Sadikin Hospital Bandung outpatient clinic. Participants underwent anthropometric measurement, laboratory, and BMD examination. Bivariate analysis was performed to determine the correlation between clinical data and BMD by Pearson or Rank–Spearman depending on data distribution. Multivariate analysis was performed to determine the most influential variables using linear regression analysis. p < 0.05 was considered statistically significant. Overall, 59 participants were included. BMD was significantly correlated with body mass index (BMI), sex, average pre-transfusion hemoglobin level, blood transfusion volume, and vitamin D, with coefficient r values of 0.47, 0.34, − 0.27, and − 0.28 (p < 0.05), respectively. BMI was the variable that most influenced BMD, with 0.39 coefficient value, an adjusted coefficient value of 0.32 (0.01–0.04), and p = 0.04. Receiver operating characteristic analysis showed BMI had the highest area under the curve (AUC) in all examination areas, especially in the hip area, with 0.800 AUC. 77.8% sensitivity, and 71.7% specificity. BMD was correlated with BMI, sex, average pre-transfusion hemoglobin level, blood transfusion volume, and vitamin D, with BMI being the most influential factor affecting BMD.