Sickle Cell and the Influence of Chronic Therapies on Bone Mineral Density
Guest: Dr. Liz Walsh – Residents, Pediatrics, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: Dr. Liz Walsh is a fellow in Pediatric Endocrinology, and is studying sickle cell anemia. Dr. Walsh, let’s talk about a study that you’re doing looking at osteoporosis, or weak bones, in children, and grown ups, who have sickle cell anemia. Why is it that weak bones are a problem in sickle cell anemia?
Dr. Liz Walsh: We’re not exactly sure why weak bones are a problem for patients with sickle cell anemia. But what we do know is that it is a problem for adults at a younger age, in their twenties and thirties. They have higher rates of having weak bones, or osteoporosis. This sets them up for an increased risk of fracture, such as hip fractures, and other fractures that don’t enable them to live a full life.
We know that with treatment, sickle cell anemia patients are now able to live more active lifestyles. And we’re screening our children, first of all, to see if they already have weak bones, and to see what different therapies patients; adults and children, are on, and which ones have a higher rate of weak bones, or less.
Dr. Linda Austin: So now, in this study, you don’t actually treat the weak bones, you evaluate who might be at risk for it?
Dr. Liz Walsh: Exactly. This is a simple observational study just to collect data. There haven’t been a great deal of studies in the pediatric population looking at sickle cell anemia and the quality of their bones. There have been a few studies in adults, but not very widespread, and certainly not looking at different patient populations in the sickle cell anemia communities.
Certain treatments we’re looking at are monthly transfusions of packed red blood cells, and hydroxyurea medication. We’re also looking at patients that don’t require any therapy. So, we’re looking at those three groups to see if there’s a difference in their bone strength, and if there’s a therapy that’s protective for bone health.
Dr. Linda Austin: So you’ll compare those different forms of treatment and see what impact they have to try to get a clue as to what is behind this?
Dr. Liz Walsh: Yes.
Dr. Linda Austin: I understand that you’re studying both children and adults with sickle cell anemia, but you’ve had more luck, so far, getting kids in the study, and so you want to underline that adults are really encouraged to participate in this study?
Dr. Liz Walsh: Yes. Anybody older than ten years of age and has sickle cell anemia, either SS or S Beta-thal, are included in the study. There aren’t any exclusion criteria for patients, but I would like them to be mobile, be walking, and not wheelchair-bound. Any of our adult population in the community, living in or outside of Charleston, is more than welcome to participate in the study. There’s no cap on the age either.
Dr. Linda Austin: If you determine that a patient in the study has weak bones, or strong bones for that matter, do you let them know the results of your findings?
Dr. Liz Walsh: We’re lucky enough here that we’re able to go through the GCRC, and they’re provided with a copy of their scan that tells them about the strength of their bones, and they can take that to their regular physician to have that evaluated.
Dr. Linda Austin: So, they get good information that they could use, potentially, to take more active steps to prevent problems?
Dr. Liz Walsh: Exactly.
Dr. Linda Austin: What is involved then if a patient is in the study? What do they have to do?
Dr. Liz Walsh: It’s really easy. It’s a nice, easy visit. You can come to MUSC one day. I just need to schedule the appointment about 48 hours in advance. They come in, and we’ll draw some blood. If you have a port, we can use your port. Or if you’re here for a transfusion and you already have an IV, we can use that as well. So, we’ll draw a small blood sample, and we’ll get a urine sample as well. And then you’ll have what’s called a DEXA scan. That’s just a radiographic image of your bones. We’re specifically looking at your hip bones and the bones in your spine, as well as a total body score. That takes about three minutes and has less radiation than an airplane flight from here to Nashville. So, those three things, and then you’ll do a quick nutritional survey. The whole thing takes less than two hours from start to finish, and then there’s a $20 Walmart gift card for participating in the study. Parking is compensated too.
Dr. Linda Austin: Right. And then you also get to find out what your bone density is, eventually, right?
Dr. Liz Walsh: Exactly.
Dr. Linda Austin: I actually just had a bone density study done, which is kind of part of normal healthcare as we get to a certain age. So it really is in keeping with just good preventive health monitoring, isn’t it?
Dr. Liz Walsh: It is. And the DEXA scan, as you know, you don’t have to be in a closed area. It’s very simple to do. It takes about three minutes.
Dr. Linda Austin: Very easy to do. And you’re really making a contribution to yourself, and other people, with sickle cell anemia.
Dr. Liz Walsh: It’s taking a proactive look at their health, yes. It’s a very easy, quick and simple, study that, I think, will be of benefit to the participants, as well as the sickle cell anemia population in general.
Dr. Linda Austin: Well, Dr. Walsh, I wish you the best of luck with this study, and I can’t wait to see what you find out.
Dr. Liz Walsh: Thank you.
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