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OSTEOPOROSIS AND SARCOPENIA IN HAEMOPHILICS WHO UNDERWENT ORTHOPEDIC MAJOR SURGERY: AN OBSERVATIONAL STUDY
CONCLUSIONS Both young and older PWH who underwent orthopedic surgery showed very high prevalence of sarcopenia and vitamin D deficiency. Low BMD occurs in adults with haemophilia more frequently than in general popula@on. Further studies are required to examine more in depth this topic.
REFERENCES: • Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People; A.J. Cruz-Jentoft et al.: Age an Ageing 2010; 39: 412-423 • The Nonskeletal Effects of Vitamin D: An Endocrine Society Scientific Statement; Rosen J, Adams JS, Bikle DD, Black DM, Demay MB, Manson JE, Murad MH, and Kovacs CS. Clifford Endocrine Reviews, June 2012, 33(3):456–492 • Orthopedic co-morbidities in the elderly haemophilia population: a review; D. Stephensen and EC Rodriguez-Merchan; Haemophilia (2013), 19, 166-173• Bone Health in persons with haemophilia; CL Kempton, DM Antoniucci, EC Rodriguez-Merchan; Haemophilia (2015), 21, 568-577
Rossella Tosini1; Marco Martinelli1; Walter Passeri1; Vincenzo Gatteri1; Stefania Pivetti1; Luisa Cigolini1; Sonia Chiari1; Andrea Zenorini1; Elena Santagostino2; Luigi Solimeno3; Luciano Bissolotti1 1Rehabilitation Center “Domus Salutis”, Teresa Camplani Foundation Brescia, Italy; 2UOS Emofilia, IRCCS Cà Granda Foundation, Milan, Italy; 3UOS Ortopedia, IRCCS Cà Granda Foundation, Milan, Italy
INTRODUCTION AND OBJECTIVE A decreased or impaired mobility is the most frequently suggested mechanism for the lower bone mineral density (BMD) in pa=ents with haemophilia (PWH). According to the physiology of the muscle-‐bone development, limited physical ac=vity leads to sarcopenia, that in turn increases the risk to develop osteopenia/osteoporosis. In this study we aimed to determine the prevalence of osteoporosis/osteopenia and sarcopenia in PWH.
RESULTS • According to World Health Organiza1on criteria to define osteoporosis, we divided pa=ents in two groups: below the age of 50 years (median age 38 ys, Body Mass Index 24,07 Kg/m2) and over the age of 50 years (median age 58 ys, Body Mass Index 24,1 Kg/m2). • Among pa>ents < 50 ys, 14.8% had osteoporosis (Z < -‐2), 40.7% presented osteopenia (-‐2 < Z score < -‐1). 88% had vitamin D below 30 ng/dl and 20% showed severe vitamin D deficiency. On the basis of European consensus on defini=on of Sarcopenia, according to SMI cut off, 83.3% had mild-‐moderate sarcopenia and 16.7% severe sarcopenia; 22.2% showed low handgrip strength (<30 kg).
MATERIALS AND METHODS We included adults (n = 54) with haemophilia A or B hospitalized in Rehabilita=on Unit aaer orthopedic major surgery (total knee, ankle and hip replacement; osteosynthesis and leg amputa=on). Lumbar and femoral dual-‐energy X-‐ray absorp=ometry (DXA) was performed to analyze BMD. Skeletal muscle mass was es=mated by bioelectrical impedance analysis (BIA 101-‐Akern) and skeletal mass index (SMI) was calculated with Bodygram PLUS soaware to classify sarcopenia (n = 34). Handgrip strength was evaluated with Jamar dynamometer (n =34). Vitamin D deficiency was also inves=gated (n = 50).
Sarcopenia in haemophilics groups 44.5%
40.7%
14.8%
Osteoporosis and osteopenia; < 50 ys
83.3
50
16.7
50
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
< 50 ys > 50 ys
12
88
200
20
40
60
80
100
> 30 ng/mL < 30 ng/mL < 10 ng/mL
25OHD; < 50 ys %
9.5
90.5
38.1
0
20
40
60
80
100
> 30 ng/mL < 30 ng/mL < 10 ng/mL
25OHD; > 50 ys %
22.2%
59.3%
18.5%
Osteoporosis and osteopenia; > 50 ys
T score > -‐1
• Among pa>ents > 50 ys, 18.5% had osteoporosis (T < -‐2.5) and 59.3% osteopenia (-‐2.5 < T score < -‐1). 90.5% showed vitamin D below 30 ng/dl and 38.1% had severe vitamin D deficiency. 50% presented mild-‐moderate sarcopenia and 50% severe sarcopenia; 73.3% exhibited low handgrip strength.
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-‐2 < Z score < -‐1
Z score > -‐1 T score < -‐2.5
-‐ 2.5 < Tscore < -‐1
severe
mild-moderate
Z score < -‐2
