Influence of Pregnancy on Bone Mass in Sickle Cell Anemia

BACKGROUND: Sickle cell disease (SCD) causes osteopenia and osteoporosis, This osteopenia may be further influenced by pregnancy. OBJECTIVE: To find out the effect of pregnancy on bone skeleton density in patients with SCD. METHODS: Consecutive adult female SCA patients who were treated at the out-patients clinics of King Fahd University Hospital Al-Khobar, Saudi Arabia, between January and July 2007, were the cases of study. Patient’s age, number of pregnancies and duration after pregnancy were documented. Weight and height were recorded to calculate body mass index (BMI). Blood was collected for haematology and biochemistry purposes. Bone mineral density (BMD) measurement was done using dual energy X-ray absorbtiometry (DEXA) at upper femur and lumbar spine. RESULTS: Thirty-eight patients were evaluated. There were 20(52.6%) patients who were delivered in (Group A) and 18(47.4%) who were nulliparous in Group B. The average age in group A was 27.55 ± 4.9 years while group B was 26.30±2.1 years. Thirteen (65%) of the patients in group A were osteoporotic when compared to five (27.7%) in group B (p=0.01)., Osteopenic patients in group B were seven (38.9%) versus four (20%) in group A (p=0.2). Osteoporosis in both groups was highest at lumbar spine compared to the hip region (P= 0.001). BMD was lower in parous women when compared to the nulliparous women. There was no significant difference in haematological parameters which included the percentage of sickle hemoglobin, hemoglobin level between normal, osteopenic and osteoporotic patient. CONCLUSION: This study shows that SCA female patients suffer from low bone mass in young age. Pregnancy predisposes the SCA patients to further osteopenia and osteoporosis.