People with hemophilia face 46% higher risk of bone fractures
Severe disease and inhibitors increase likelihood of painful breaks: Study
Written by |
- People with hemophilia face a 46% higher risk of bone fractures.
- Severe disease and inhibitors significantly increase fracture likelihood.
- Increased awareness, prevention, and bone health monitoring are needed.
People living with hemophilia face a 46% higher risk of bone fractures than the general population, with that risk increasing for those with severe disease or a history of treatment-blocking antibodies.
These are the findings of a large-scale Canadian study that highlights a growing health concern for patients as they live longer, more active lives. The data reveal that nearly 9% of hemophilia patients experienced a bone break during the study period, compared to less than 6% of their peers without bleeding disorders. For those with inhibitors — antibodies that neutralize standard treatments — the risk of a fracture more than doubled.
Disease severity and “the presence or history of an inhibitor are major risk factors for a bone fracture,” researchers noted, emphasizing that these patients require more than clotting support to stay healthy.
The study, “Evaluation of the Burden of Bone Fractures in People Living With Haemophilia: A Registry-Based Matched Cohort Study,” was published in Haemophilia.
A growing concern for aging patients
Hemophilia is a rare disorder caused by a lack of functional clotting factor proteins — factor VIII in hemophilia A and factor IX in hemophilia B. As a result, patients often experience excessive and prolonged bleeding episodes, including bleeding into the joints.
As life expectancy for people with hemophilia has increased in recent decades, largely thanks to the “availability of several treatment options and improved care coordination and delivery,” age-related conditions such as low bone mineral density and osteoporosis have become growing concerns, the researchers wrote.
Poor bone health in people with hemophilia may develop over time due to the disease and its complications. Recurrent bleeding episodes, joint damage, and chronic pain may reduce mobility and limit physical activity. In turn, these factors can interfere with normal bone development and the ability to reach and maintain healthy bone mass.
“Low bone mineral density increases the risk of fractures,” the researchers wrote. However, while previous studies have linked the disease to reduced bone mineral density, data on fracture risk remain limited.
To evaluate the “burden of fractures” among people with hemophilia, a team of researchers in Canada analyzed data from the Canadian Bleeding Disorders Registry and the Institute for Clinical Evaluative Sciences. The study included 1,080 people with hemophilia in 2017 and 21,597 individuals without bleeding disorders, matched for age and sex, who served as controls. Participants were followed through the end of March 2018.
Participants were mostly male (97.7%) and ranged in age from 17 to 56 years. Most patients (75.8%) had hemophilia A. Nearly half of the patients (48.3%) had mild hemophilia, 19.6% had moderate disease, and 32.1% had severe hemophilia.
Overall health status was similar between people with hemophilia and those in the control group, with comparable rates of common chronic conditions, such as heart and lung disease and diabetes.
Identifying the highest risk groups
The results showed that 8.7% of people with hemophilia experienced a bone fracture during the study period, compared with 5.7% in the control group.
After accounting for age, other health conditions, and disease characteristics, people with hemophilia were found to have a 46% higher risk of fractures overall.
Among patients, those with severe hemophilia had a 72% higher risk of fractures than those with mild disease. Risk was also more than doubled in patients with current or past inhibitors, which are antibodies produced against standard replacement therapies. These antibodies are called inhibitors because they can stop replacement therapies from working as well as they should.
Together, the findings highlight the need for greater awareness of bone fracture risk in hemophilia and provide data that may help inform future decisions around prevention efforts, resource planning, and bone health monitoring in this population, the researchers wrote.
