PB0644 - Evaluation of the burden of bone fractures in people living with hemophilia: a registry-based case-control study.

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Federico Germini, MD, MSc, PhD

Assistant Professor
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada

Co-Author(s)

CC

Chatree Chai-Adisaksopha, MD

Assistant Professor
Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
Chiang Mai, Chiang Mai, Thailand
QI

Quazi Ibrahim

Statistician
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
EI

Emma Iserman

Statistical Analyst
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
MR

Melissa Rattle

Registered Nurse
Niagara Health, Niagara, ON
St. Catherines, Ontario, Canada
AK

Arun Keepanasseril

Assistant Professor
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
Hamilton, Ontario, Canada
AI

Alfonso Iorio

Professor
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
Davide Matino, MD (he/him/his)

Assistant Professor
Department of Medicine, Division of Hematology, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada

Background: Bone diseases, such as low bone mineral density (BMD) and osteoporosis are emerging concerns in people with hemophilia (PWH). As a consequence, PWH might experience fractures more frequently than the general population.

Aims: Our primary aim was to compare the incidence of bone fractures in PWH and people with no bleeding disorders. The secondary aim was to identify the risk factors associated with bone fractures in PWH.

Methods: This was a retrospective, case-control, study based on data from the Canadian Bleeding Disorders Registry and administrative data from the Institute for Clinical Evaluative Sciences (ICES). PWH were eligible if born before Jan 1, 2017, and alive on April 1, 1993. They were followed up to March 31, 2018. Age- and sex-matched controls with no bleeding disorders were randomly selected with a 20:1 case:control ratio. We analyzed the data using multivariate regression models, adjusting for age, severity, and inhibitor status, and comorbidities (Charlson Comorbidity index).

Results: 1,080 PWH and 21,597 controls were included. The participants’ characteristics are reported in Table 1. 8.7% of PWH and 5.7% of controls experienced a fracture during the follow-up period. The adjusted hazard ratio (aHR) for a fracture was 1.46 [95% confidence interval (CI) 1.19; 1.80] in PWH as compared to controls. The results of the multivariable analysis in PWH are reported in Table 2. Severe hemophilia [adjusted odds ratio (aOR) 1.72, 95%CI 1.02; 2.93] and the presence or history of an inhibitor (aOR 2.42, 95%CI 1.08; 5.42) were risk factors for a fracture, after adjusting for age and comorbidities.

Conclusion(s): PWH have a higher risk of bone fractures than the general population. Among PWH, the severity of hemophilia and the presence or history of an inhibitor are risk factors for a bone fracture.