{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T14:19:27Z","timestamp":1781878767488,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T00:00:00Z","timestamp":1651276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp; Metabol"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To delineate the prevalence and associated risk factors of low BMD, osteoporosis\/bone fragility and fracture in transfusion\u2010dependent thalassemia (TDT) in the Chinese population in Hong Kong.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Patients and Measurements<\/jats:title><jats:p>A retrospective cohort study design was employed. Patients of TDT who had serial Hologic dual\u2010energy X\u2010ray absorptiometry (DXA) from 2010 to 2016 and received regular transfusion for at least 5\u2009years were recruited. Clinical and biochemical data, from 5\u2009years before the first DXA scan, were retrieved from the electronic record system of the Hospital Authority, till 30 June 2020. Low bone mineral density and osteoporosis\/bone fragility are defined by the ISCD 2019 position guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010seven patients were included in the analysis. The fracture prevalence of TDT among the Chinese population in Hong Kong was 15.58%. Up to 55.84% of patients had low bone mineral density, and 5.19% patients had osteoporosis\/bone fragility state. The median age at first fracture was 31.73\u2009years (range 24.06\u201344.18\u2009years). In the regression analysis, a higher log(10) transformation of average ferritin levels over 5\u2009years before the first DXA scan was significantly associated with fracture occurrence regardless of bisphosphonate treatment (OR 310.73, 95% CI 3.99\u201324183.89, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.010). Mean average ferritin level over 5\u2009years was 6695.5\u2009\u00b1\u20092365.7\u00a0pmol\/L (fracture group) versus 4350.7\u2009\u00b1\u20093103.2\u00a0pmol\/L (non\u2010fracture group), <jats:italic>p<\/jats:italic>\u00a0=\u00a0.016. Hip and spine BMD <jats:italic>Z<\/jats:italic>\u2010score did not have statistically significant association with fracture occurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Iron overloading plays an important role in adverse bone health in TDT. Dual X\u2010ray densitometry is insufficient in predicting fracture risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/edm2.340","type":"journal-article","created":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T01:59:00Z","timestamp":1651370340000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence and risk factors of fractures in transfusion dependent thalassemia \u2013 A Hong Kong Chinese population cohort"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6354-5882","authenticated-orcid":false,"given":"Samantha Lai Ka","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Endocrinology Department of Paediatrics Hong Kong Children's Hospital  Hong Kong SAR China"},{"name":"Department of Paediatrics The Chinese University of Hong Kong  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond Siu Ming","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Haematology Department of Medicine Prince of UK Hospital  Hong Kong SAR China"},{"name":"Department of Medicine The Chinese University of Hong Kong  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Kong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Paediatrics The Chinese University of Hong Kong  Hong Kong SAR China"},{"name":"Division of Haematology Department of Paediatrics Hong Kong Children 's Hospital  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing Kwan","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Paediatrics The Chinese University of Hong Kong  Hong Kong SAR China"},{"name":"Division of Haematology Department of Paediatrics Hong Kong Children 's Hospital  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2016.10.013"},{"issue":"4","key":"e_1_2_9_3_1","first-page":"261","article-title":"A synopsis of current care of thalassaemia major patients in Hong Kong","volume":"17","author":"Au WY","year":"2011","journal-title":"Hong Kong Med J"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2018048"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2005.10.001"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ph11040107"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2015-1105"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/crad.2000.0492"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-018-4650-2"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00033.2015"},{"key":"e_1_2_9_11_1","unstructured":"2019 ISCD Official Positions \u2013 Adult \u2013 International Society for Clinical Densitometry (ISCD). Iscd.org. https:\/\/www.iscd.org\/official\u2010positions\/2019\u2010iscd\u2010official\u2010positions\u2010adult\/. Published 2020. Accessed June 14 2020."},{"key":"e_1_2_9_12_1","unstructured":"2019 ISCD Official Positions \u2013 Pediatric \u2013 International Society for Clinical Densitometry (ISCD). Iscd.org. https:\/\/www.iscd.org\/official\u2010positions\/2019\u2010iscd\u2010official\u2010positions\u2010pediatric\/. Published 2020. 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