Link between hemophilia and fracture risk: Evidence from a meta-analysis

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Created On: 02/08/2025

Haemophilia A and B are chronic bleeding disorders frequently linked with decreased bone mineral density in both pediatric and adult populations.

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Key take away

People with hemophilia have a significantly higher risk of fractures—over four times greater—when compared to the general population.

Background

Haemophilia A and B are chronic bleeding disorders frequently linked with decreased bone mineral density in both pediatric and adult populations. Nonetheless, it remains unclear whether individuals with hemophilia face a heightened risk of fractures. This study aimed to consolidate and evaluate existing evidence on the connection between hemophilia and fracture risk.

Method

In this systematic review and meta-analysis, a thorough literature search was carried out across 3 electronic databases—PubMed, CENTRAL, and Scopus. Relative risk (RR) estimates with 95% confidence intervals (CI) were calculated, and the I² statistic was used to determine heterogeneity among the studies.

Result

A total of 14 studies were included for qualitative synthesis, and 4 for meta-analysis, encompassing 13,221 volunteers and spanning publications from 2007 to 2022. The study designs comprised 2 case-control studies, 5 retrospective cohort studies, and 7 cross-sectional studies. The prevalence of fractures in people with hemophilia was 5.7%, with individual study ranges from 1.4% to 27.7%.

In contrast, fracture prevalence among control groups was 0.9%, ranging from 0% to 5.1% across 3 studies. When compared to healthy individuals, people with hemophilia exhibited a substantially elevated risk of fractures (RR 4.56; I² = 90.74%). However, data were insufficient to examine fracture distribution by anatomical site, treatment modality (prophylaxis vs. on-demand), or hemophilia subtype and severity.