Hypogonadism and Hormone Replacement Therapy on Bone Mass of Adult Women with Thalassemia Major

Carmina, Enrico; Fede, Gaetana Di; Napoli, Nicola; Renda, Giovanni; Vitale, Giustina; Pinto, Carmela Lo; Bruno, Dario; Malizia, R; Rini, G. B.

doi:10.1007/s00223-002-1044-3

Cited by 46 publications

(29 citation statements)

References 12 publications

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“…BMD was measured in all subjects by dual X-ray absorptiometry (DXA) [9]. Exclusion criteria included kidney disease, gastrointestinal disorders and steroid and sex steroid therapy.…”

Section: Methodsmentioning

confidence: 99%

Dairy calcium intake and lifestyle risk factors for bone loss in hiv-infected and uninfected mediterranean subjects

et al. 2012

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BackgroundDespite the reported high prevalence of osteoporosis in the human immunodeficiency virus (HIV)-population, there have been no previous studies examining dairy calcium intake and bone mineral density (BMD) in HIV-subjects.We assessed the prevalence of low BMD in HIV-infected and uninfected subjects and analyzed the effects of calcium intake, lifestyle and HIV-related risk factors on BMD.MethodsOne hundred and twelve HIV-infected subjects were consecutively enrolled. Seventy- six HIV-uninfected subjects matched for age and sex were enrolled as the control group. The HIV-subjects were interviewed about lifestyle habits and completed a weekly food-frequency questionnaire to estimate calcium intake. HIV-RNA, CD4+ T-cell count and data on antiretroviral therapy were also recorded. Both biochemical bone turnover markers and BMD, assessed by dual-energy radiographic absorptiometry (DXA) were recorded in the HIV-cases and controls. We also calculated the 10-year fracture risks using the WHO FRAX equation.ResultsOsteoporosis prevalence was significantly higher in the HIV-cases than controls (p < 0.05). BMI values were positively correlated with BMD (p < 0.05). Vitamin D levels were lower in the HIV-subjects (p < 0.02). No correlation was found with daily calcium intake.BMI values were significantly correlated with dairy intake quartiles (p < 0.003). In HIV-subjects, the mean of FRAX score was 1.2 % for hip and 4.7 % for major osteoporotic fractures. On multivariate analysis of the lumbar spine DXA T-score, age (p < 0.005) and HIV/hepatitis C virus co-infection (p < 0.0001) were negatively correlated with BMD, while yogurt intake was a protective predictor of BMD (p < 0.05). In the femur DXA T-score, age (p < 0.01), nadir CD4 + T-cell count < 200 cells/μL (p < 0.05) and drug addiction ( p < 0.0001) were negatively correlated with BMD.ConclusionsAmong the foods rich in calcium, yogurt was a protective predictor of BMD in HIV-subjects. HIV/HCV co-infection, nadir CD4 + T-cell count < 200 cells/μL and drug addiction were independent predictors of severe BMD. Promoting behavioral changes in food intake and lifestyle, aimed at the primary prevention of bone disease in the chronically-infected subjects seems to be essential for implementing medical intervention in these cases.

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“…BMD was measured in all subjects by dual X-ray absorptiometry (DXA) [9]. Exclusion criteria included kidney disease, gastrointestinal disorders and steroid and sex steroid therapy.…”

Section: Methodsmentioning

confidence: 99%

Dairy calcium intake and lifestyle risk factors for bone loss in hiv-infected and uninfected mediterranean subjects

et al. 2012

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“…In spite of the improved treatment of the hematologic disorder and its complications, β -thalassemia patients exhibit an unbalance in bone mineral turnover with increased resorptive rates and suppression of osteoblast activity, resulting in diminished bone mineral density (BMD) more evident in the lumbar spine [8, 9]. Putative mechanisms involved in the pathogenesis of bone abnormalities in β TM are discussed in the following subsections.…”

Section: Pathogenesis Of Bone Changes In β-Thalassemiamentioning

confidence: 99%

Physiopathology of Bone Modifications inβ-Thalassemia

Perisano

Marzetti

Spinelli

et al. 2012

Anemia

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β-thalassemia major (βTM) or Cooley anemia is characterized by significantly reduced or absent synthesis of β-globin chains, which induces important pathologic consequences including hemolytic anemia, altered erythropoiesis, and bone marrow overstimulation. The pathogenesis of bone changes in patients with βTM is not yet completely understood. However, an unbalance in bone mineral turnover resulting from increased resorption and suppression of osteoblast activity has been detected in βTM patients. The abnormal regulation of bone metabolism may be related to hormonal and genetic factors, iron overload and iron chelation therapy, nutritional deficits, and decreased levels of physical activity. Here, we review the most recent findings on the physiopathology of bone abnormalities in βTM. Clinical presentation and radiological features of βTM-related bone changes are also discussed.

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“…Regarding the hormonal replacement therapy (HRT), there is conflicting evidence on its clinical effectiveness in maximizing bone mass in TM patients. Some studies have shown beneficial effect of HRT especially in younger patients [8, 11] while some others have shown little or no effect of HRT on BMD in thalassaemics who presumably have not achieved peak bone mass [30]. …”

Section: Hypogonadotrophic Hypogonadismmentioning

confidence: 99%

Osteoporosis Syndrome in Thalassaemia Major: An Overview

Toumba

Skordis

2010

Journal of Osteoporosis

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Osteoporosis in thalassaemia major (TM) represents a prominent cause of morbidity. The mechanism of pathogenesis of bone disease (BD) in TM is multifactorial and complicated. Peak bone mass is achieved shortly after completion of puberty and normally remains stable until the third decade of life when age-related bone mass begins. Growth hormone (GH) and sex steroids play a crucial role in bone remodeling and in the maintenance of skeletal architecture during adult life. GH and insulin growth factors (IGFs) have anabolic effect in bone formation. Sex steroids act probably by increasing the expression of RANKL by osteoblastic cells and alterations in the RANK/RANKL/OPG system in favor of osteoclasts. Impaired GH secretion and lack of sex steroids in thalassemic patients due to pituitary damage, contribute to failure of achieving optimal peak bone mass. Other endocrine complications such as hypoparathyroidism and vitamin D deficiency have also a detrimental role on bones in TM. It is still questionable whether the international criteria for defining osteopenia and osteoporosis are relevant to patients with TM; also a question arises for the diagnostic methods such as DEXA scan and management of osteoporosis with known treatment protocols, in the thalassaemic patient.

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Hypogonadism and Hormone Replacement Therapy on Bone Mass of Adult Women with Thalassemia Major

Cited by 46 publications

References 12 publications

Dairy calcium intake and lifestyle risk factors for bone loss in hiv-infected and uninfected mediterranean subjects

Dairy calcium intake and lifestyle risk factors for bone loss in hiv-infected and uninfected mediterranean subjects

Physiopathology of Bone Modifications inβ-Thalassemia

Osteoporosis Syndrome in Thalassaemia Major: An Overview

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