Low bone mass density is associated with hemolysis in brazilian patients with sickle cell disease

Abstract

OBJECTIVES:To determine whether kidney disease and hemolysis are associated with bone mass density in a population of adult Brazilian patients with sickle cell disease. INTRODUCTION:Bone involvement is a frequent clinical manifestation of sickle cell disease, and it has multiple causes; however, there are few consistent clinical associations between bone involvement and sickle cell disease.METHODS:Patients over 20 years of age with sickle cell disease who were regularly followed at the Hematology and Hemotherapy Center of Campinas, Brazil, were sorted into three groups, including those with normal bone mass density, those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared using statistical analyses.RESULTS:In total, 65 patients were included in this study: 12 (18.5%) with normal bone mass density, 37 (57%) with osteopenia and 16 (24.5%) with osteoporosis. Overall, 53 patients (81.5%) had bone mass densities below normal standards. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p<0.05). Osteoporosis patients also had decreased hemoglobin levels (p<0.05). Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance, or microalbuminuria.CONCLUSION:A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased reticulocyte counts and low hemoglobin levels.

Bone Remodeling and Energy Metabolism: New Perspectives

“…Changes in mammalian HSCs may affect the progression of MSCs into osteoblasts or adipocytes (104,105,106). For example, low bone mass is a feature of individuals with hemolytic anemia, a clinical condition associated with enhanced marrow adiposity (107)(108)(109).…”

Bone Disease in Haemoglobin Disorders

“…Several studies have shown an overall reduction in BMD in children and adults with SCD (9,(12)(13)(14). In recent studies, according to WHO criteria, 70-80% of SCD patients were osteoporotic or osteopenic (15)(16)(17).…”

“…Several factors, including reduced haemoglobin levels, chronic haemolytic anaemia, hyperplasia of the bone marrow, abnor- mally low body mass index (BMI), increased ferritin levels, vitamin D deficiencies and low plasma zinc or sex steroid levels, have been previously correlated with reduced BMD in adult patients with SCD (17)(18)(19). Furthermore, reduced physical activity and decreased circulating GH are likely contributing factors (20,21).…”

“…Bone formation markers (bonespecific alkaline phosphatase b-ALP; osteocalcin, OC) as well bone resorption markers (C-telopeptide of collagen type I, CTX) levels were found to be elevated (16,17).…”

Could Denosumab Support Bone Integrity in Sickle Cell Disease

“…In a study a total of 65 SCD patients. It revealed 18.5% with normal BMD, 57% with osteopenia and 16 24.5% with osteoporosis, the overall, 53 patients (81.5%) had BMD below normal standards [9]. Normal bone vasculature is essential for skeletal development, modeling, remodeling, growth, and healing processes.…”