Effects of strontium ranelate on bone mass and bone turnover in women with thalassemia major-related osteoporosis

Morabito, Nunziata; Catalano, Antonino; Gaudio, Agostino; Morini, E.; Bruno, Lucia Maria; Basile, Giorgio; Tsiantouli, Eleni; Bellone, Federica; Agostino, Rita Maria; Piraino, Beth; Rosa, Maria Angela La; Salpietro, Carmelo; Lasco, Antonino

doi:10.1007/s00774-015-0689-8

Cited by 27 publications

(25 citation statements)

References 33 publications

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“…In a small study of 24 patients with thalassemia major, treatment with strontium ranelate improved BMD and normalized bone turnover markers, as well as lowering serum sclerostin levels (233). However, the use of strontium ranelate will require caution given the increased baseline risk of thromboembolism (234) and cardiac iron overload in transfusion-dependent thalassemia.…”

Section: Others (Zinc Teriparatide Strontium Ranelate Denosumab mentioning

confidence: 98%

Bone Disease in Thalassemia: A Molecular and Clinical Overview

et al. 2016

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Thalassemia bone disease is a common and severe complication of thalassemia-an inherited blood disorder due to mutations in the α or β hemoglobin gene. In its more severe form, severe anemia is present, and treatment with frequent red blood cell transfusion is necessary. Because the body has limited capacity to excrete iron, concomitant iron chelation is required to prevent the complications of iron overload. The effects of chronic anemia and iron overload can lead to multiple end-organ complications such as cardiomyopathy, increased risks of blood-borne diseases, and liver, pituitary, and bone disease. However, our understanding of thalassemia bone disease is incomplete and is composed of a complex piecemeal of risk factors that include genetic factors, hormonal deficiency, marrow expansion, skeletal dysmorphism, iron toxicity, chelators, and increased bone turnover. The high prevalence of bone disease in transfusion-dependent thalassemia is seen in both younger and older patients as life expectancy continues to improve. Indeed, hypogonadism and GH deficiency contribute to a failure to achieve peak bone mass in this group. The contribution of kidney dysfunction to bone disease in thalassemia is a new and significant complication. This coincides with studies confirming an increase in kidney stones and associated accelerated bone loss in the thalassemia cohort. However, multiple factors are also associated with reduced bone mineral density and include marrow expansion, iron toxicity, iron chelators, increased bone turnover, GH deficiency, and hypogonadism. Thalassemia bone disease is a composite of not only multiple hormonal deficiencies but also multiorgan diseases. This review will address the molecular mechanisms and clinical risk factors associated with thalassemia bone disease and the clinical implications for monitoring and treating this disorder.

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Section: Others (Zinc Teriparatide Strontium Ranelate Denosumab mentioning

confidence: 98%

Bone Disease in Thalassemia: A Molecular and Clinical Overview

et al. 2016

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“…At the time of this writing, although SR has been used for the treatment of osteoporosis in several countries; neither the U.S. Food and Drug Administration nor Health Canada have approved its use. With this in mind, Morabito and colleagues gave 2 g of SR or placebo to 24 transfusion‐dependent Italian patients (all female, age: 40 ± 4 years) . After 2 years, BMD increased significantly at the spine, markers of bone formation and IGF‐1 increased, resorption markers decreased, and back pain progressively resolved in those provided SR compared to placebo.…”

Section: Low Bone Massmentioning

confidence: 99%

The importance of nutrition for health in patients with transfusion‐dependent thalassemia

Fung

2016

Annals of the New York Academy of Sciences

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Nutrition is increasingly being seen by care providers as important for patients with thalassemia. However, the definition of optimal nutritional support and the means to provide that support remain elusive. This review focuses on the relationships between nutritional status and three common comorbidities in patients with thalassemia: low bone mass, growth deficiency, and diabetes. The association between low bone mass and specific nutrient deficiencies (e.g., vitamin D, zinc) is clear, while the role of nutritional adequacy for young patients with growth deficiencies requires careful analysis to distinguish it from chronic anemia and endocrine insufficiency. Correction of isolated nutritional deficiencies in small cohorts of patients with thalassemia has shown some promise at improving both bone health and linear growth in the short term. However, the long-term safety and acceptability of these practices need to be evaluated. On the whole, there are few well-designed, adequately powered studies of the role of general dietary or specific micronutrients in the cause, treatment, or prevention of these commonly observed morbidities in thalassemia. Until these data are gathered, it is suggested that patients with thalassemia be monitored frequently and that their nutritional deficiencies be corrected when observed in order to advance their overall health and quality of life.

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“…By inhibiting the Wnt signaling pathway, sclerostin, a non-classical bone morphogenetic protein (BMP) antagonist, has been identified as a negative regulator of bone formation, and its effect can be inhibited by using strontium ranelate [10]. Common risk factors for osteoporosis include a personal history of fracture, current low bone mass, or body mass index (BMI), advanced age, female gender, menopausal status, low lifetime calcium intake, vitamin D deficiency, an inactive lifestyle or extended bed rest, and use of corticosteroids [1].…”

Section: Introductionmentioning

confidence: 99%

Iron Deficiency Anemia as a Risk Factor for Osteoporosis in Taiwan: A Nationwide Population-Based Study

et al. 2017

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The cause-effect relationship between iron deficiency anemia (IDA) and osteoporosis has not been established in the general population. Thus, the current longitudinal study determined the role of IDA as a risk factor for osteoporosis by analyzing a large nationwide population-based sample. In a sample of 1,000,000 randomly sampled individuals from the 1998–2012. Taiwan National Health Insurance Research Database, patients with IDA (case group (n = 35,751)) and individuals without IDA (control group (n = 178,755)) were compared. Patients who were <20 years of age and who had pre-existing osteoporosis prior to the diagnosis of IDA were excluded. Each patient with IDA was age- and gender-matched to five individuals without IDA. The diagnoses of IDA and osteoporosis (coded using ICD-9CM) were further confirmed with blood test results and X-ray bone densitometry to ensure the accuracy of the diagnoses. Osteoporosis occurred more often among patients with IDA compared to individuals without IDA (2.27% vs. 1.32%, p < 0.001). Cox proportional hazard analysis revealed that the risk for osteoporosis was significantly higher in the case than the control group (hazard ratio (HR) = 1.74; 95% CI = 1.61–1.88) and remained similar after adjustment for covariates (adjusted HR = 1.81; 95% CI = 1.67–1.97). Compared with individuals without IDA, the risk for osteoporosis was even higher for patients with IDA who received intravenous ferrum therapy (adjusted HR = 2.21; 95% CI = 1.85–2.63). In contrast, the risk for osteoporosis was reduced for patients with IDA who received a blood transfusion (adjusted HR = 1.47; 95% CI = 1.20–1.80). As a predictor, prior IDA is a significant and independent risk factor for development of osteoporosis.

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Effects of strontium ranelate on bone mass and bone turnover in women with thalassemia major-related osteoporosis

Cited by 27 publications

References 33 publications

Bone Disease in Thalassemia: A Molecular and Clinical Overview

Bone Disease in Thalassemia: A Molecular and Clinical Overview

The importance of nutrition for health in patients with transfusion‐dependent thalassemia

Iron Deficiency Anemia as a Risk Factor for Osteoporosis in Taiwan: A Nationwide Population-Based Study

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