| Objective To explore the effect of secondary iron accumulation on bone metabolism by analyzing bone mineral density (BMD) in patients with transfusion-associated iron accumulation. Methods The 54 cases of transfusion-associated iron accumulation included 22 aplastic anemia (AA)，25 myelodysplastic syndrome ( MDS)，and 7 primary myelofibrosis ( PMF) patients. All patients were treated with blood transfusion for a minimum of 0. 5 years, up to 9 years. Hemoglobin, hematocrit and related biochemical indexes were measured before blood transfusion at each visit. Serum ferritin, transferrin, and lumbar spine and femoral neck BMD were measured at the end of the study. The relationships between BMD and iron metabolism were studied using Student’s t-test, variance analysis, Chi square test, Pearson/Spearman correlation analysis, multiple regression analysis, and partial correlation analysis. Results The mean serum ferritin was 1273. 14 ng/ml, which was significantly above the normal ranges. The mean T/Z scores for BMD at lumbar spine and femoral neck were - 1. 75 and - 1. 48 respectively, which were below the normal ranges. Patients were divided into AA, MDS, and PMF groups. The differences among the three groups in both BMD and prevalence of osteopenia/osteoporosis were not of statistical significance (P> 0. 05 ). Patients were divided into osteopenia/ osteoporosis and normal bone mass groups. Osteopenia/osteoporosis (67%) was strongly associated with older age, longer blood transfusion period, higher incidence of diabetes, lower serum albumin and higher serum ferritin and lower serum transferrin. The correlations analysis showed that BMD of both lumbar spine and femoral neck was correlated positively with body mass index, hemoglobin, hematocrit, serum albumin and transferrin (P <0. 05) , and negatively with age, blood transfusion treatment time, and serum ferritin (P <0. 05). Further multiple regression analysis showed that age and serum ferritin were the main factors influencing the BMD at lumbar spine and femoral neck. Adjusted for age, BMD at lumbar spine and femoral neck showed negative correlation with the serum ferritin ( r = - 0. 53，- 0. 40，P < 0. 05 ). Conclusion Patients with transfusion-associated iron accumulation had lower BMD, and BMD was negatively correlated with level of iron accumulation. The results provide new clinical evidences for studying the relationship between secondary iron accumulation and bone metabolism. |