The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?

Abstract

Hemolytic anemia (HA) renders erythropoietic stress on the bone marrow and has been linked to osteoporosis. In this nationwide retrospective cohort study, we examined this correlation by utilizing the Taiwan National Health Insurance Research Database (NHIRD). We identified two cohorts, matching population with and without HA in a 1:4 ratio. A total of 2242 HA patients and 8968 non-HA patients were enrolled. Patients with HA had a significantly higher cumulative incidence (log-rank test p = 0.0073), higher incidence density (5.11 vs. 3.76 per 1000 persons-years), and a 1.31-fold risk of developing osteoporosis than non-HA patients (aHR = 1.31, 95% C.I. 1.04–1.63, p = 0.01). After adjusting for age, sex, and comorbidities, patients with factors including female (aHR = 2.57, 95% C.I. 2.05–3.22, p < 0.001), age > 65 (aHR = 9.25, 95% C.I. 7.46–11.50, p < 0.001), diagnosis of cholelithiasis (aHR = 1.76, 95% C.I. 1.20–2.58, p = 0.003) and peptic ulcer disease (aHR = 1.87, 95% C.I. 1.52–2.29, p < 0.001) had significantly higher risk of osteoporosis. We propose that this correlation may be related to increased hematopoietic stress, increased consumption of nitric oxide (NO) by hemolysis, and the inhibitory effects of iron supplements on osteogenesis through the receptor activator of nuclear factor κB ligand (RANKL)/Osteoprotegerin pathway and the Runt-related transcription factor 2 (RUNX2) factor. Our findings suggest that patients with hemolytic anemia are at a higher risk of developing osteoporosis, and it would be in the patient’s best interest for physicians to be aware of this potential complication and offer preventative measures.

How mycobacterium tuberculosis infection could lead to the increasing risks of chronic fatigue syndrome and the potential immunological effects: a population-based retrospective cohort study

“…Our study has several limitations. As our previous study of LHID [ 50 , 51 ], data on patient history, including symptoms, occupation status, contact history, and disease severity, are unavailable in NHIRD. Furthermore, the study population was mainly composed of East Asian people living in Taiwan, which limits the generalizability of the findings to other ethnicities.…”

Assessment of factors influencing physicians’ intention to prescribe transfusion using the theory of planned behavior

“…Therefore, blood transfusions are not the rst line treatment for IDA but are effective for osteoporosis protection in HA. [2,3]…”

“…3, 2021, 129 valid questionnaires were collected. Respondents (Table3) were predominately men (72.1%, 93/129).…”

Kruppel-like Factors in Skeletal Physiology and Pathologies

“…The KLF1 E325R mutation is associated with congenital dyserythropoietic anemia, which causes severe hemolytic anemia in patients [ 150 , 151 ]. Patients with hemolytic anemia are known to have a significantly high risk of developing early onset osteopenia [ 152 ], and an increased risk of nonvertebral osteoporotic fractures in elderly men [ 153 ]. As the cell-autonomous roles played by KLF1 in skeletal cells are still unknown, these observations could be due to the nonskeletal cell-autonomous roles played by KLF1.…”