Beta-thalassemia trait: an underrecognized risk for osteoporosis in postmenopausal women, warranting screening

Summary This case series presents two postmenopausal women with beta-thalassemia trait who developed osteoporosis. Case 1 involves a woman in her 70s presenting with persistent lower back pain; imaging revealed a compression fracture at L2, and a DEXA scan confirmed osteoporosis with a forearm T-score of −3.8 and a femoral neck T-score of −2.5. Case 2 describes a woman in her late 50s with generalized bone pain and severe osteoporosis identified through DEXA scanning, with a lumbar spine T-score of −3.3. Both patients lacked classical secondary causes of bone loss, and laboratory evaluations were unremarkable. Family history was notable for osteoporosis in first-degree relatives, though the relatives’ thalassemia status was unknown. Both patients declined injectable therapies and were managed with oral alendronate, calcium, and vitamin D supplementation. These cases highlight beta-thalassemia trait as a potential underrecognized risk factor for osteoporosis in postmenopausal women, suggesting the need for further research and consideration in clinical guidelines. Learning points Beta-thalassemia trait may predispose to osteoporosis, even without iron overload or transfusion dependence. Postmenopausal women with beta-thalassemia trait should undergo early DEXA screening to prevent fractures. Patient preference impacts management: oral bisphosphonates are viable when injectables are refused. Guideline gaps: current osteoporosis protocols do not address beta-thalassemia trait as a risk factor.