Bone turnover markers and bone mineral density in children with haemophilia

Abstract

During childhood growth, bone undergoes modelling involving separate osteoblastic and osteoclastic processes. Markers of bone turnover circulate at high concentrations, parallel the childhood growth curve and correlate with height velocity. The aim of this study was to compare serum markers of bone turnover in children with haemophilia and normal bone mineral density (BMD) vs. those with low BMD. In a cross-sectional study, 69 children with haemophilia were evaluated, 45 children with normal spine BMD vs. 24 with low BMD. Lumbar spine BMD was determined using dual X-ray absorptiometry and Z-scores were calculated. Serum samples of markers of bone turnover, osteocalcin (bone formation) and C-telopeptide of type I collagen (bone resorption) were measured using ELISA. The mean BMD (g cm(-2) ) in the normal group was 0.656 ± 0.15 vs. 0.558 ± 0.12 in those with low BMD (P = 0.007), osteocalcin levels in children with normal BMD were 9.29 ± 4.97 vs. 7.06 ± 2.17 ng μL(-1) in the low BMD group (P = 0.012). C-telopeptide levels in the normal group were 1.06 ± 1.4 vs. 0.74 ± 0.3 ng mL(-1) in the low BMD group (P = 0.169). Our results showed that low osteocalcin levels predominated in the group with low BMD, which indicates a diminished osteoblastic bone formation activity while there were no differences with regard to bone resorption markers. Moreover, osteocalcin levels explain 10% of the variation of lumbar spine Z-score.

Evaluation of bone mineral density in Turkish children with severe haemophilia A: Ankara hospital experience

“…Our results were compatible with previous studies [23,24]. In a study conducted by Tlacuilo-Parra et al [25], the authors suggested that low osteocalcin levels predominated in the group with low BMD, which indicates a diminished osteoblastic bone formation activity.…”

Low bone mineral density and associated factors in patients with haemophilia in Colombia

“…This suggests that haemophilia, because of its physiopathology or complications from the disease itself like arthropathy, favours abnormal bone loss . This study showed that haemophilic patients with arthropathy are more likely to have LBMD, similar to findings by Tlacuilo‐Parra et al, and Wells et al among others …”

“…Interpreting DXA results by age with either T ‐ or Z ‐score, the present study showed that patients younger than 50 years with haemophilia have a 2.65 times higher risk of LBMD when compared to healthy participants. This result is similar to findings by Tlacuilo‐Parra et al in a matched case‐control study of 62 participants in Mexico . There was no significant difference in BMD in participants 50 years or older; however, the low number of patients (n = 7) included in this age group may have limited the statistical power to detect significant differences.…”

Orthopaedic co‐morbidities in the elderly haemophilia population: a review

“…Similar prevalence levels have been reported in younger men with haemophilia and worryingly reduced BMD has also been observed in children with severe haemophilia , although initiating prophylaxis before the age of 3 years may result in BMD levels comparable to persons without haemophilia . It is thought that early prophylaxis encourages greater participation in physical activity and thus maintenance of normal bone density.…”