Investigation of the relationship between bone mineral density and dynamic stability in children with hemophilic arthropathy

Introduction and aim: The present study aimed to score hemophilic arthropathy caused by intraarticular bleeding andto investigate the relationship between dynamic stability and bone mineral density (BMD) in patients followed up in our Pediatric Hematology department due to a diagnosis of severe hemophilia Aand also to analyze the changes in preexisting pathologies following an exercise program. By investigating dynamic instabilities, we aimed to provide a better understanding of the effect of recurrent intraarticular bleeding on dynamic stability and to establish a more effective, protective, and rehabilitative treatment plan. Materials and Methods: The study included 16 male patients aged 8-17 years who were being followed up and were receiving prophylactic therapy at YuzuncuYil University DursunOdabas Medical Center Hematology polyclinic due to a diagnosis of hemophilia A (factor VIII deficiency). The patients were divided into two groups as home exercise group (n=8) and hospital exercise group (n=8). For both groups, the exercise program was planned as three days a week for a total of five weeks. Patients in the home exercise group were given a brochure and were instructed on how to perform the exercises at homeand patients in the hospital exercise group performed the same exercises in the hospital under the supervision of a physical therapist. Both before and after the exercise program, each patient underwent dynamic stability test on a dynamic platform posturography device with sway referencing of the surface thatallowed the assessment of the senses of static, dynamic stability and proprioception, and on which rehabilitative exercise could be performed for the improvement of these senses.During the test, the ATE and the number of turns were recorded for each patient. Additionally, both before and after the exercise program, an International Prophylaxis Study Group (IPSG) scoring of hemophilic arthropathy was performed using the magnetic resonance imaging (MRI) studies of the hip, knee, and ankle and BMD was assessed by dual energy x-ray absorptiometry (DEXA) using the z-score.The results of both groups were compared to evaluate the differences in the hemophilic arthropathy scores assessed after the exercise program, the ATE and the number of turns for the sense of dynamic stability, and the z-score assessed for the changes in BMD. Results: The z-scores assessed for the changes in BMD after the exercise program showed remarkable improvement. However, no significant difference was found with regard to the sense of dynamic stability and the number of turns and a decrease was noted in ATE values after the exercise program. On the other hand, varying degrees of hemophilic arthropathy was detected in patients in both groups and a significant difference was found in the arthropathy scores for the left ankle in both groups and in the arthropathy scores for the right ankle in the hospital exercise group. Conclusion: The results indicated that the sense of dynamic stability was not affected after the exercise program in both groups. This finding could be attributed to the fact that the patients were in the pediatric age group and their sense of dynamic stability might be impaired in later ages.On the other hand, patients with low BMD were planned for an etiological investigation. The results also indicated that the z-scores assessed by DEXA and the hemophilic arthropathy scores improved after the exercise program. However, the differences detected in the parameters examined in the study were statistically insignificant, which could be associated with the short duration of the exercise program and the short intervals between the follow-up checks. Taken together, the results of the present study implicate that physical exercise programs and physical therapy and rehabilitation applications are needed to improve and preserve stability and to protect BMD and joint health in patients with hemophilic arthropathy