Fracture prevalence in thalassemia: a systematic review and meta-analysis

Background Multiple observational studies have reported high prevalence of fracture in patients with thalassemia. However, most of these studies have included limited number of patients, and only few of them have reported prevalence of fracture among patients with different types and severity of thalassemia. Objective This systematic review and meta-analysis was conducted to summarize all available data of fracture prevalence among patients with thalassemia. Methods A systematic review was conducted using EMBASE and MEDLINE databases from inception to June 2021 to determine studies that reported prevalence of fracture in thalassemia patients. The pooled prevalence with 95% confidence interval (95%CI) of fracture across studies was determined using a random-effect, generic inverse variance method. Results After two rounds of systematic review, a total of 25 studies with 4934 patients were included in the meta-analysis. The pooled prevalence of fracture among patients with thalassemia was 16% (95%CI, 15-17%, I-2 = 94.3%). The subgroup analyses showed that the pooled prevalence of fracture was 4% (95%CI, 2-6%; I-2 = 70.4%) among patients with alpha thalassemia, 17% (95%CI, 16-19%; I-2 = 93.2%) among patients with beta thalassemia, 18% (95%CI, 16-19%; I-2 = 89.0%) among patients with transfusion-dependent thalassemia, and 7% (95%CI, 4-10%; I-2 = 94.2%) among patients with non-transfusion-dependent thalassemia. Conclusion Fracture is common in patients with thalassemia, and may be more prevalent in beta thalassemia and transfusion-dependent thalassemia than in alpha thalassemia and non-transfusion-dependent thalassemia.