Beyond osteoporosis in sickle cell disease: high bone mineral density, disorganised bone and fracture risk.

We describe a patient with sickle cell disease and unexpectedly high bone mineral density. Dual-energy X-ray absorptiometry and high-resolution imaging demonstrated globally increased density with structural heterogeneity, increased porosity and abnormal bone organisation. This suggests altered bone remodelling in sickle cell disease, in which high density may mask impaired bone quality with potential implications for skeletal fragility.