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General Updates | Monitoring patients with thalassemia for the development of bone disease
In this video, Julian Waung, BM, PhD, Whittington Hospital, London, UK, provides insight on how to monitor for the development of bone disease in patients with thalassemia. Dr Waung notes that monitoring involves a combination of longitudinal imaging using dual-energy X-ray absorptiometry (DEXA) scans, biochemistry measurements, and questions about lifestyle factors. This interview took place virtually.
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Transcript
So the way I monitor it is a combination of some imaging studies, some biochemistry, and then questions about risk factors that can be modified.
So from an imaging perspective, I use a DEXA scan, which is kind of the gold standard for monitoring bone. The important thing to be aware of is that for thalassemia, the spine has got a lot of degenerative changes, so it’s not a very reliable site...
So the way I monitor it is a combination of some imaging studies, some biochemistry, and then questions about risk factors that can be modified.
So from an imaging perspective, I use a DEXA scan, which is kind of the gold standard for monitoring bone. The important thing to be aware of is that for thalassemia, the spine has got a lot of degenerative changes, so it’s not a very reliable site. So actually we should use the hip and I use the total hip to monitor that. And it’s an imprecise measurement, so about a 4.5% difference between scans is what’s more meaningful and usually at an interval of 18 to 24 months.
In terms of biochemistry, bone turnover markers, if available, are very helpful. That measures the formation and breakdown of bone. And then also the endocrine status.
I do a urine calcium, a 24 hour screen for urine calcium, because hypercalciuria, which is the loss of calcium in the urine, is a very big risk factor and quite prevalent in thalassemia.
And then lifestyle factors. Is the patient smoking? What’s their alcohol intake? Are they doing weight bearing exercise? Do they have enough dairy in their diet? Is their vitamin D adequate? Those kind of things.
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