• In addition to a diet rich in calcium and vitamin D, your doctor
may recommend taking calcium and/or vitamin D supplements.
by Janice Beatty, RN, BSN and Craig Butler
Check with your doctor about the need for these supplements.
What can be done to treat low bone mass?
Following all of the above prevention measures is important in treating low bone mass, to help insure that there is no further
Why is low bone mass an issue in thalassemia?
decrease. In addition, some doctors may prescribe a drug in the
Having bones that grow and develop into strong,
bisphosphonate family, such as Pamidronate or Etidronate. Some
healthy bones is important for everyone. Low bone
research trials have indicated that IV administration of Zoledronic
mass refers to weakness of the bones or bones that
acid may be beneficial to patients with thalassemia and
osteoporosis; other trials are investigating whether increasing zincintake may have a beneficial outcome for this patient population.
There are many factors that may determine why any
Future studies will prove helpful in assessing the value of these and
individual has low bone mass, including the genes
s/he inherited from parents, dietary patterns and theamount of weight-bearing exercise the individual
If you have further questions about osteoporosis and thalassemia, talk
engages in regularly. However, people with
with your health care professional or contact the Cooley’s Anemia
thalassemia are also more prone to develop bone
Foundation at (800) 522-7222 or firstname.lastname@example.org.
mass difficulties due to factors specifically related tothalassemia or its treatment, such as anemia,
The Thalassemia Centers of Excellence have the most highly trained
overactive bone marrow, excess iron deposited in the
thalassemia experts in the country. They are located at:
bones, reactions to deferoxamine and endocrine-related problems such as delayed puberty or
Children’s Hospital Los AngelesChildren’s Hospital Oakland
What is osteopenia?
Osteopenia occurs when a person has low bone mass,
but not so low as to be diagnosed with osteoporosis.
Weill Medical College of Cornell University (New York)
(Sometimes osteopenia is defined as “reduced bone
mass,” while osteoporosis is defined as “low bone
Many other hospitals are satellite centers affiliated with these
Centers. Please contact the Cooley’s Anemia Foundation for a list of
The World Health Organization defines osteopenia asoccurring when a person’s Bone Mineral Density (BMD)
Published by the Cooley’s Anemia Foundation
T-score is between -1 and -2.5. The WHO defines
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osteoporosis as occurring when a person’s BMD T-
This publication is made possible by an unrestricted educational grant
What is osteoporosis?
Osteoporosis is defined as a thinning of the bones,with a reduction in bone mass due to a loss of
The information in this publication is for educational purposes only and is not intended
calcium and bone protein. In osteoporosis, bones
to substitute for medical advice. You should not use this information to diagnose or
become porous and brittle, are unable to support
treat a health problem of disease without consulting a qualified health care provider.
The Cooley’s Anemia Foundation strongly encourages you to consult your health care
weight easily and fracture more readily.
provider with any questions you may have regarding your condition.
What are problems associated with low bone mass?
• An appropriate transfusion regimen, as determined with your
A person with low bone mass, especially osteoporosis, is
doctor. As anemia and overactive bone marrow are thought to
more likely to experience fractures. Once fractured,
contribute to osteoporosis, keeping hemoglobin at an appropriate
bones may take longer to heal or heal more poorly than
level can decrease the risk of developing low bone mass.
the bones of a person with normal bone mass.
Osteoporosis can affect a person’s posture, impair
• Maintaining adequate chelation therapy. Excess iron in the bones is
physical activity and mobility and may create some
a factor in low bone mass, so rid the body of as much iron as
physical changes as the skeletal system becomes
• Treatment of endocrine issues that may affect bone mass, such as
Although any bone in the body can be affected by osteoporosis, the
delayed puberty/hypogonadism. Some doctors may prescribe sex
bones most vulnerable to fracture tend to be in the hip, spine, wrist
How is low bone mass diagnosed?
Most people who have low bone mass are unaware of it; bone loss
• Regular exercise. Patients should first
may occur for a long time without any visible symptoms. As a result,
discuss an appropriate exercise schedule with
it is often undiagnosed until after a fracture occurs. Because it
occurs with such frequency in thalassemia, individuals with
thalassemia intermedia or thalassemia major should be checked
exercise routine. For the general population,
regularly by having a Bone Mineral Density (BMD) test on an annual
basis starting at around 8 years old. BMD is measured by a dual
recommends that a person engage in three or
energy x-ray absorptiometry test, commonly called a DEXA scan.
four 20-30 minute exercise sessions per week,
The BMD measurement will enable your doctor to determine your T-
with the exercise focusing on weight-bearing
score or Z-score and to determine if you have osteopenia or
activities. For adults, some appropriate activities may include: brisk
osteoporosis. The doctor should also check nutritional status and
walking, jogging, running, aerobics, step classes, dancing, circuit
vitamin levels (especially calcium and vitamin D).
What are T-scores and Z-scores?
• Maintain a diet rich in calcium and vitamin D. This diet must also
A T-score measures a patient’s BMD against that of a normal, healthy
take into account restrictions that patients may have in terms of
30-year-old. A score of “0” means a patient’s BMD is equal to that
excess iron, heart issues, diabetes, or other factors; consulting a
of a normal, healthy 30-year-old. A score above 0 means the
nutritionist who understands your specific issues is advised.
patient’s BMD is greater than normal; a score below 0 means it islower than normal. As mentioned above, a score of -1 to -2.5
Following are some foods and drinks that are good sources of calcium:
indicates osteopenia; a score lower than -2.5 indicates osteoporosis.
* Dairy products such as milk, yogurt and cheese (Note that skim
A Z-score measures BMD compared to a typical, healthy person
milk actually contains more calcium than regular milk)
whose age is the same as the patient. Because low bone mass can
* Dark green leafy vegetables such as broccoli, collard greens,
occur at a much younger age in thalassemia than in the general
spinach, turnip greens, Brussels sprouts and bok choy
population, a Z-score may provide a physician with information that
* Also tofu, okra, white beans, baked beans, rhubarb, peas, nuts,
is more relevant in assessing bone mass in a person with thalassemia.
What can I do to prevent low bone mass?
Again, remember that selecting the right mix of calcium-rich foods
Because thalassemia makes them predisposed to low bone mass,
for your diet must also take into consideration other issues that may
people with thalassemia should take extra efforts to keep their bone
mass at healthy levels; some steps that can be taken include:
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