Tesis

Prevalens dan Faktor yang Berhubungan dengan Densitas Massa Tulang Rendah dan Osteoporosis pada Anak dengan Thalassemia Mayor di Rumah Sakit Cipto Mangunkusumo = Prevalence and associated factors of low BMD and osteoporosis in thalassemia major patients in Cipto Mangunkusumo hospital.

Latar belakang. Meningkatnya kesintasan pada pasien thalassemia memungkinkan manifestasi komplikasi serius, seperti osteoporosis. Prevalens osteoporosis pada pasien thalassemia mayor di luar negeri dilaporkan 40-50%, namun di Indonesia belum diketahui. Keterlambatan diagnosis dan tata laksana terhadap massa tulang yang rendah menyebabkan tingginya morbiditas dan penurunan kualitas hidup pasien. Tujuan. Mengetahui prevalens DMT rendah dan osteoporosis pada pasien thalassemia mayor usia 7-12 tahun dan hubungan DMT dengan rerata kadar hemoglobin pretransfusi per tahun, rerata kadar serum feritin per tahun, kadar vitamin D dan kalsium, serta lama sakit. Metode. Penelitian ini adalah penelitian potong lintang yang dilakukan pada 50 pasien thalassemia mayor usia 7-12 tahun di RSCM selama Mei-Juni 2021. Pemeriksaan DMT tulang lumbal dan TBLH menggunakan DXA dari GE lunar di radiologi RSCM Kencana. Penilaian data demografik, lama sakit, riwayat fraktur, keluhan nyeri tulang dan status antropometri dilakukan melalui anamnesis dan pemeriksaan fisis langsung oleh peneliti. Data kadar hemoglobin pretransfusi, serum feritin, kalsium ion, dan rontgen vertebra diperoleh dari EHR RSCM. Data kadar vitamin D diperoleh dari hasil laboratorium Prodia. Hasil. Prevalens pasien thalassemia mayor berusia 7-12 tahun di RSCM dengan DMT rendah adalah 52%, dengan prevalens osteoporosis sebesar 20%. Tidak ada korelasi bermakna antara skor Z DMT tulang lumbal ataupun TBLH dengan rerata kadar hemoglobin pretransfusi per tahun (r= 0,035, p= 0,809; r= 0,154, p= 0,285), rerata kadar serum feritin per tahun (r= -0,026, p= 0,860; r= 0,041, p= 0,778), kadar vitamin D (r= 0,011, p= 0,940; r= 0,008, p= 0,959), kalsium ion (r= -0,143, p= 0,321; r= -0,194, p= 0,178), dan lama sakit (r= 0,016, p= 0,914; r= -0,086, p= 0,553). Kesimpulan. Prevalens DMT rendah pada pasien thalassemia mayor usia 7-12 tahun adalah 52%, sedangkan prevalens osteoporosis pada pasien thalassemia mayor adalah 20%. Tidak ada hubungan DMT dengan rerata kadar hemoglobin pretransfusi per tahun, rerata kadar serum feritin per tahun, kadar vitamin D dan kalsium, serta lama sakit.
Kata kunci: densitas massa tulang, osteoporosis, prevalens, thalassemia mayor


Background. Increased survival in thalassemia major patients allowed for serious complications to manifest, such as osteoporosis. The global prevalence of osteoporosis in well treated thalassemia major patients is approximately 40–50%, but it is still unknown in Indonesia. The lack of early diagnosis of low bone mineral density (BMD) and treatment has led to increased morbidity and lowered quality of life. Objective. To determine the prevalence of low BMD and osteoporosis in thalassemia major patients aged 7-12 years and correlation between BMD and mean pretransfusion hemoglobin level, mean serum ferritin level, vitamin D level, ionized calcium level, and duration of the disease. Methods. This study was cross-sectional, conducted on 50 thalassemia major patients, aged 7-12 years, from Mei to June 2021 in Cipto Mangunkusumo Hospital (CMH). The BMD in lumbal spine and TBLH were measured by GE lunar DXA in radiology department of Kencana CMH. The demographic data, duration of the disease, fracture history, bone pain, and anthropometric status were attained by history taking and physical examination. The data of pretransfusion hemoglobin level, serum ferritin level, ionized calcium level, and spine x-ray were attained from EHR and vitamin D level from Prodia laboratory. Result. The prevalence of low BMD in thalassemia major patients aged 7-12 years is 52%, and the prevalence of osteoporosis is 20%. There was no correlation between BMD in lumbal spine or TBLH and mean pretransfusion hemoglobin level (r= 0,035, p= 0,809; r= 0,154, p= 0,285), mean serum ferritin level (r= -0,026, p= 0,860; r= 0,041, p= 0,778), vitamin D level (r= 0,011, p= 0,940; r= 0,008, p= 0,959), ionized calcium level (r= -0,143, p= 0,321; r= -0,194, p= 0,178), and duration of the disease (r= 0,016, p= 0,914; r= -0,086, p= 0,553). Conclusion. The prevalence of low BMD in thalassemia major patients aged 7-12 years is 52% and the prevalence of osteoporosis is 20%. No correlation between BMD and mean pretransfusion hemoglobin level, mean serum ferritin level, vitamin D level, ionized calcium level, and duration of the disease.
Keywords: bone mineral density, osteoporosis, prevalence, thalassemia major