Table 1.

Schematic summary of factors that may contribute to TBD and their management

Factor	Key mechanism	Treatment	Prevention
Bone marrow expansion	Ineffective erythropoiesis	Transfusion at optimal Hb levels	Transfusion at optimal Hb levels
Iron overload	Iron toxicity	Optimal iron chelation	Early and regular iron chelation
Iron chelation	Overchelation; drug toxicity	Tune chelation intensity on iron overload; avoid high doses	Tune chelation intensity on iron overload
Hypogonadism	Iron toxicity	Replacement therapy	Early and regular iron chelation
Hypoparathyroidism	Iron toxicity	Replacement therapy	Early and regular iron chelation
Hyperparathyroidism	Vitamin D deficiency	Vitamin D2 or D3	Vitamin D2 or D3
Hypothyroidism	Iron toxicity	Replacement therapy	Early and regular iron chelation
GH	Iron toxicity	Replacement therapy	Early and regular iron chelation
Diabetes	Iron toxicity	Replacement therapy	Regular iron chelation; lifestyle
Liver disease	Viral hepatitis; iron toxicity	Antiviral therapy; regular iron chelation	Safe blood; regular iron chelation
Vitamin D deficiency	Iron toxicity	Vitamin D2 or D3	?
Renal disease	Hypercalciuria	Correct causes	?
Vitamin C deficiency	Iron toxicity	Vitamin C–rich diet	Optimal iron chelation

Hb, hemoglobin TBD, thalassemia bone disease.