الفهرس 
Title : Assessment of Bone Density by DXA in a group of Egyption Children with b-Thalassemia: Correction of Hepatic Iron Overload by Manual Analysis
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Abstract
Introduction: Beta thalassemia major (BTM) is characterized by anemia and iron overload, especially with inadequate chelation therapy. Dual energy x-ray absorptiometry
(DXA) may misanalyse bone measurements due to iron deposition in organs such as
the liver.
Aim: The aim of this work was to study difference between the posterior-anterior
spine measurements of bone mineral content (BMC), area (BA) and density (BMD) in
poorly chelated beta thalassemia patients with and without inclusion of the liver in the
DXA analysis.
Methods: We studied hemoglobin and serum ferritin concentrations in 67 child
patients with BTM. Posteroanterior spine measurements BMC, BA and areal BMD
were performed using DEXA scan, analysis was carried out including and excluding
(manually) the iron overloaded liver. Machine generated Z-scores of L1-L4 BMD
were used for analysis.
Results: The mean age of the study group was7.66 ± 1.97 yr. Mean hemoglobin and
serum ferritin concentrations were 5.20 ± 0.71 g/dl and 2287.33 ± 1101.16 ng/ml,
respectively. The mean BMC, BA, and BMD at the lumbar spine were 16.60 ± 4.11 g,
36.70 ± 7.21 cm2 and 0.44 ± 0.08 g/cm2 respectively with inclusion of liver that is
standard machine analysis. After the liver was excluded from the analysis, the mean
BMC, BA, and BMD were 16.87 ± 4.16 g, 36.04 ± 6.01 cm2 and 0.46 ± 0.08 g/cm2,
respectively and the BMD was significantly greater (p < 0.05). Mean BMD Z-score
was -4.1 – 1.9, which significantly (p < 0.05) improved to -4.2 – 1.9 after exclusion of
the liver from the analysis.
Conclusion: Based on the results of the current study, the caution needs to be
exercised in the analysis of DXA scans in poorly chelated thalassemic patients;
inclusion of the iron-overloaded liver in the tissue analysis may exaggerate the deficit
in bone density parameters. Manual analysis may be required to reduce the pseudo effect of highly attenuating material like the iron-overloaded liver on bone parameters at the lumbar spine.