BONE loss in haemophilia is strongly influenced by disease severity and the timing of prophylactic treatment, with early initiation offering clear protection against osteoporosis, according to a large multicentre European study. These data were presented at EAHAD 2026, where the study was awarded the second poster prize.
Bone Loss in Haemophilia Without Prophylaxis
The study assessed bone mineral density in 224 patients with haemophilia and 224 healthy controls matched for age and body mass index across 23 centres in Europe. Patients with severe, moderate, and mild haemophilia were included, while those with positive HIV status or inhibitors were excluded. Bone mineral density was measured at the femoral neck and lumbar spine, with osteopenia defined by a T-score between −1 and −2.5 and osteoporosis by a T-score below −2.5.
Among patients with severe haemophilia who had never received prophylaxis, osteoporosis prevalence was markedly higher than in matched controls: 24.2% versus 3%, respectively (odds ratio: 13.8; 95% CI: 1.34–142; p=0.03). Hepatitis C virus infection further increased osteoporosis prevalence in this group to 46.7% compared with 5.6% in uninfected counterparts (odds ratio: 14.9; 95% CI: 1.56–142).
Impact of Prophylaxis Timing
The protective effect of prophylaxis depended strongly on the age at initiation. Patients with severe haemophilia who started prophylaxis after the age of 20 years had a threefold higher prevalence of osteoporosis than matched controls: 33.3% versus 10.4% (odds ratio: 3.75; 95% CI: 1.24–11.3). Osteopenia was also substantially more common in this group at 83.3% compared with 47.9% in controls (odds ratio: 9.5; 95% CI: 2.21–40.8).
In contrast, osteoporosis and osteopenia prevalence did not differ significantly from controls in patients who began prophylaxis before the age of 20 years, nor in those with moderate or mild disease.
Clinical Implications for Bone Health
Bone loss in haemophilia was more frequent in haemophilia A than haemophilia B, particularly among patients without prophylaxis or those starting prophylaxis after 20 years of age. These findings highlight the importance of early preventive strategies and routine bone mineral density monitoring in high risk groups.
The authors conclude that initiating prophylaxis before 20 years of age effectively prevents bone loss, while delayed or absent prophylaxis leaves patients vulnerable to osteoporosis.
Reference
Tardy B et al. European prospective case–control study evaluating the prevalence of bone loss in patients with hemophilia: PHILEOS study. Abstract PO044. EAHAD 2026 Annual Meeting; 3-6th February 2026.
