{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:39:18Z","timestamp":1787927958446,"version":"build-2784847793"},"reference-count":42,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,12,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Conventional treatment of thalassemia, namely regular blood transfusion and iron chelation, improves perspectives and quality of life; however, successful treatment leads to more time in which long-term complications such as bone disease can develop. Thalassemia bone disease (TBD) is unique: all aspects, from bone anatomy and bone quality to mineral density, may be affected, with important morbidity including osteoporosis, fractures, spinal deformities, nerve compression, and pain. Clinical presentations include growth impairment, rickets-like features, back pain, spinal deformities, any sign of nerve compression, severe osteoporosis, and fragility fractures. Age, history, physical examination, and diagnostic tests support orientation on risk factors. These include bone marrow expansion, toxicity from iron overload and iron chelation, endocrine dysfunctions (hypogonadism, hypohyperparathyroidism, hypothyroidism, growth hormone deficiency, diabetes), and vitamin (D, C, K) and zinc deficiencies. Several of these may coexist in an individual for a long time and at different degrees, making clarification of the relative contribution and selection of the best therapeutic options a challenge. Milestones for prevention of TBD are early and full inhibition of bone marrow hyperplasia and iron toxicity. Empowering patients\u2019 positive resources is key for achieving long-term healthy habits with regard to diet, physical activity, sunlight exposure, and lifestyle. Pain, related or unrelated to bone disease, is frequent in thalassemia. The most important targets for the hematologist include having an expert orientation on disease-related causes of pain, driving differential diagnosis, providing effective pain relief and, where feasible, removing the cause.<\/jats:p>","DOI":"10.1182\/asheducation-2017.1.272","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T18:13:11Z","timestamp":1555438391000},"page":"272-277","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":62,"title":["Impact of bone disease and pain in thalassemia"],"prefix":"10.1182","volume":"2017","author":[{"given":"Antonio","family":"Piga","sequence":"first","affiliation":[{"name":"Department of Clinical and Biological Sciences, University of Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"key":"2019111709515616900_B1","volume-title":"J Bone Miner Res","author":"Steer","year":"2017"},{"issue":"6","key":"2019111709515616900_B2","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1007\/s00277-017-2959-0","article-title":"Bone quality in beta-thalassemia intermedia: relationships with bone quantity and endocrine and hematologic variables","volume":"96","author":"Baldini","year":"2017","journal-title":"Ann Hematol"},{"issue":"1","key":"2019111709515616900_B3","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s11739-011-0745-x","article-title":"Bone disease in adult patients with \u03b2-thalassaemia major: a case-control study","volume":"9","author":"Baldini","year":"2014","journal-title":"Intern Emerg Med"},{"issue":"1","key":"2019111709515616900_B4","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.crad.2005.07.006","article-title":"The radiological appearances of thalassaemia","volume":"61","author":"Tyler","year":"2006","journal-title":"Clin Radiol"},{"key":"2019111709515616900_B5","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.bone.2016.09.023","article-title":"The regulation of iron metabolism by hepcidin contributes to unloading-induced bone loss","volume":"94","author":"Xu","year":"2017","journal-title":"Bone"},{"key":"2019111709515616900_B6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3389\/fphar.2017.00077","article-title":"Clinical impact and cellular mechanisms of iron overload-associated bone loss","volume":"8","author":"Jeney","year":"2017","journal-title":"Front Pharmacol"},{"key":"2019111709515616900_B7","volume-title":"J Bone Miner Res","author":"Morabito","year":"2004"},{"key":"2019111709515616900_B8","volume-title":"Osteoporos Int","author":"Angelopoulos","year":"2006"},{"issue":"4","key":"2019111709515616900_B9","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/bjh.12048","article-title":"Prospective study of histomorphometry, biochemical bone markers and bone densitometric response to pamidronate in \u03b2-thalassaemia presenting with osteopenia-osteoporosis syndrome","volume":"159","author":"Chatterjee","year":"2012","journal-title":"Br J Haematol"},{"issue":"5","key":"2019111709515616900_B10","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/BF01955263","article-title":"Growth and development in thalassaemia major patients with severe bone lesions due to desferrioxamine","volume":"155","author":"De Sanctis","year":"1996","journal-title":"Eur J Pediatr"},{"issue":"5","key":"2019111709515616900_B11","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s00277-016-2633-y","article-title":"Longitudinal changes of endocrine and bone disease in adults with \u03b2-thalassemia major receiving different iron chelators over 5 years","volume":"95","author":"Poggi","year":"2016","journal-title":"Ann Hematol"},{"issue":"12","key":"2019111709515616900_B12","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1002\/ajh.23844","article-title":"Endocrine function and bone disease during long-term chelation therapy with deferasirox in patients with \u03b2-thalassemia major","volume":"89","author":"Casale","year":"2014","journal-title":"Am J Hematol"},{"key":"2019111709515616900_B13","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.bone.2016.01.011","article-title":"Deferasirox at therapeutic doses is associated with dose-dependent hypercalciuria","volume":"85","author":"Wong","year":"2016","journal-title":"Bone"},{"issue":"2","key":"2019111709515616900_B14","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s00277-012-1558-3","article-title":"Nephrolithiasis in beta thalassemia major patients treated with deferasirox: an advent or an adverse event? 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