Building Bones in Thalassemia Patients
New Bone Density Study in Patients with Thalassemia Shows Need for Intervention at Younger Ages
Low bone mass is a significant problem in the thalassemia population, with approximately 50 to 90 percent of adults with thalassemia presenting with low bone mass. While in previous decades thalassemia treatment was more focused on immediate concerns over managing iron overload and its associated problems, such as heart disease and cardiac events, improvements in iron overload treatment has improved patients' long-term outlook.
"What this means for patients is that now that they are living longer with less immediate threats, they are at increased risk for bone pain and fracture at a young age," says Dr. Fung.
"What our results show is that even after controlling for potential artifacts, thalassemia patients still have extremely low bone mass when compared with healthy counterparts," Dr. Fung says. "Not only that, but we were able to use the pQCT to assess different types of bone and overall bone strength in thalassemia patients as well."
Dr. Fung discovered that the size of the bones themselves were much smaller in thalassemia patients than in healthy controls, and had a significantly smaller outside circumference.
"In addition, the cortical shell, which is the part of the bone which makes it strong both in terms of compression and lateral movement, was also significantly thinner in thalassemia patients than healthy controls," says Dr. Fung.
The general approach to treating low bone mass in thalassemia patients has been to prescribe osteoporosis drugs once these patients reach adulthood. Osteoporosis medications generally are used to decrease bone breakdown, which is elevated in thalassemia. The results of Dr. Fung's study, however, indicate that this is potentially too little, too late. Not only is bone breakdown elevated in thalassemia, but bone formation is significantly reduced.
Currently Dr. Fung is undertaking studies to asses different approaches to enhancing bone formation, including using vibration platforms, vitamin D and zinc supplementation, as well as looking at increasing physical activity in patients by fully characterizing patients' current activity to see how best to improve it.
"Even with all the other significant issues in thalassemia that deserve attention, if we want to have any affect on bone mass in thalassemia patients we absolutely must start looking at ways of building patients' bones when they are younger."
Friday, June 10, 2011 9:56 AM