Diminished cortical bone density of long bones among children with haemophilic arthropathy

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia 2023-01, Vol.29 (1), p.274-281
• Main Authors: Tlacuilo‐Parra, Alberto, Soto‐Padilla, Janet, Toro‐Castro, Luis, Gutierrez‐Hermosillo, Violeta, Guevara‐Gutierrez, Elizabeth
• Format: Article
• Language: English
• Subjects: Arthritis; Bone and Bones; Bone Density; Bone health; Bone mineral density; Bones; Cancellous bone; Child; Children; Cortical Bone; Cortical bone density; Cross-Sectional Studies; Haemophilia joint health score; Hemophilia; Hemophilia A - complications; Humans; Long bone; Male; Physical activity; Quantitative ultrasound; Radius; Radius - diagnostic imaging; Statistical analysis; Ultrasonography; Ultrasound
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.14682

Introduction Children with haemophilia (CwH) have lower bone mineral density in the spine (trabecular bone) than healthy children. There are few studies focusing on bone mineral density in long bones (cortical bone). Aim To evaluate bi‐laterally the distal third of radius and midshaft tibias using quantitative ultrasound (QUS) and assess the speed of sound (SoS). Methods A cross‐sectional study where 91 CwH and 91 age‐matched healthy boys were included. Joint evaluation was determined with the Haemophilia Joint Health Score 2.1 and SoS values. The Z scores were measured with the Sunlight Omnisense 8000 S equipment. Results Ninety‐one CwH (haemophilia A) were evaluated (26 mild form, 26 moderate, and 39 severe). Most patients were treated with on‐demand factor replacement and had higher total HJHS scores according to severity (4.8, 14.8 and 14.1, respectively). Patients with moderate and severe disease showed a statistical difference in SoS values for both radius and tibias compared to controls. QUS Z‐scores ≥‐2 were more frequent in radius and tibias in CwH, but were statistically significant only in tibias when compared to controls (in 30% mild, 46% moderate, 28% severe, respectively). Conclusions There was diminished cortical bone density in radius and tibias of CwH compared to healthy controls. Changes predominated in tibias, more frequently affected according to the severity of haemophilia. Early intervention with factor replacement combined with physical activity are key aspects to promote bone health.