EVALUATION OF OSTEOPATHY IN PATIENTS WITH BETA-THALASSEMIA MAJOR USING DIFFERENT IRON CHELATION THERAPIES

Ali Jalal Shawkat; Ahmed Hamed Jwaid; Ghada Marzouq Awad; Hayder Adnan Fawzi

doi:10.22159/ajpcr.2018.v11i11.29079

Authors

Ali Jalal Shawkat Department of Clinical Pharmacy, Ministry of Health, Iraq.
Ahmed Hamed Jwaid Department of Pharmacology, College of Pharmacy, University of Baghdad, Baghdad, Iraq.
Ghada Marzouq Awad Hereditary Blood Disorders Centre, AL-Karama Teaching Hospital, Baghdad, Iraq.
Hayder Adnan Fawzi Clinical Pharmacist, Baghdad Medical City, Baghdad, Iraq. http://orcid.org/0000-0001-9970-0119

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i11.29079

Keywords:

Beta-thalassemia major, Osteoporosis, Osteopenia, Deferoxamine, Parathyroid

Abstract

Objective: We aim to assess the bone mineral density (BMD) and bone biochemical parameters in Iraqi patients with Î²-thalassemia major (Î²-TM).

Methods: Dual-energy X-ray absorptiometry scan was used to evaluate bone density and interpreted about Z-score which compares to the BMD of age-, sex-, and ethnicity-matched reference population. Biochemical parameters such as calcium, 25-OH Vitamin D, parathyroid hormone, and serum ferritin (SF) evaluated.

Results: No statistical difference in SF between pediatrics and adults was determined; however, 66 patients were having their SF between 1000 and 2500 ng/ml and 122 patients with SF Ëƒ2500 ng/ml. Calcium and Vitamin D levels are low in both adults and pediatrics. The bone status shows high percentages of osteoporosis 62% and 54.5% for pediatrics and adults, respectively, as well as osteopenia 27% and 34.3% for both pediatric and adults and to a lesser extent normal bone status 11% for each.

Conclusion: Osteopathy has a high prevalence in Iraqi patients with Î²-TM and should receive an optimal transfusion and chelation therapy to prevent bone expansion. Calcium and Vitamin D should be routinely determined to prevent deficiency.

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Author Biography

Hayder Adnan Fawzi, Clinical Pharmacist, Baghdad Medical City, Baghdad, Iraq.

Clinical Pharmacy Board

Clinical Research

References

Marengo-Rowe AJ. The thalassemias and related disorders. Proc (Bayl Univ Med Cent) 2007;20:27-31.

Devarshi S, James S, Najafzadeh E, Pawar S, Kalrao V, Bafna V. Assessment of quality of life, complications and post-transfusion adverse reactions in thalassemia pediatric in tertiary care hospital. Int J Pharm Pharm Sci 2016;8:317-20.

Muncie HL, Jr., Campbell J. Alpha and beta thalassemia. Am Fam Physician 2009;80:339-44.

Kadhim KA, Baldawi KH, Lami FH. Prevalence, incidence, trend, and complications of thalassemia in Iraq. Hemoglobin 2017;41:164-8.

Jha R, Jha S. Beta thalassemia-a review. J Pathol Nepal 2014;4:633-71.

Aydinok Y. Thalassemia. Hematology 2012;17 Suppl 1:S28-31.

Tyagi P, Kumar Y, Gupta D, Singh H, Kumar A. Therapeutic advancements in management of iron overload-a review. Int J Pharm Pharm Sci 2015;7:35-44.

Makroo RN, Bhatia A. Provision of ideal transfusion support-the essence of thalassemia care. Apollo Med 2014;11:184-90.

Fuqua BK, Vulpe CD, Anderson GJ. Intestinal iron absorption. J Trace Elem Med Biol 2012;26:115-9.

Toumba M, Skordis N. Osteoporosis syndrome in thalassaemia major: An overview. J Osteoporos 2010;2010:537673.

De Sanctis V, Soliman AT, Elsefdy H, Soliman N, Bedair E, Fiscina B, et al. Bone disease in Î² thalassemia patients: Past, present and future perspectives. Metabolism 2018;80:66-79.

Terpos E, Voskaridou E. Treatment options for thalassemia patients with osteoporosis. Ann N Y Acad Sci 2010;1202:237-43.

Zainal AA. Biochemical bone profile in thalassemia major patients on desferrioxamine therapy. Tikrit Med J 2010;16:122-8.

Alizzi FJ, Abbas WA, Fawzi HA. Assessment of the role of cholecystokinin in hyperemesis gravidarum and correlation with its severity. J Pharm Sci Res 2018;10:272-5.

Rofinda AZ, Arb F. Vitamin D and parathyroid hormone levels and their relation to serum ferritin levels in children with thalassemia major: One-center study in western Indonesia. J Adv Med Pharm Sci 2017;15:1-5.

Goyal M, Abrol P, Lal H. Parathyroid and calcium status in patients with thalassemia. Indian J Clin Biochem 2010;25:385-7.

Angelopoulos NG, Goula A, Rombopoulos G, Kaltzidou V, Katounda E, Kaltsas D, et al. Hypoparathyroidism in transfusion-dependent patients with beta-thalassemia. J Bone Miner Metab 2006;24:138-45.

Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinicianâ€™s guide to prevention and treatment of osteoporosis. Osteoporos Int 2014;25:2359-81.

Valizadeh N, Farrokhi F, Alinejad V, Said Mardani S, Valizadeh N, Hejazi S, et al. Bone density in transfusion dependent thalassemia patients in urmia, iran. Iran J Ped Hematol Oncol 2014;4:68-71.

Lorente Ramos RM, Azpeitia ArmÃ¡n J, ArÃ©valo Galeano N, MuÃ±oz HernÃ¡ndez A, GarcÃa GÃ³mez JM, Gredilla Molinero J, et al. Dual energy X-ray absorptimetry: Fundamentals, methodology, and clinical applications. Radiologia 2012;54:410-23.

Pirinccioglu AG, Akpolat V, Koksal O, Haspolat K, Soker M. Bone mineral density in children with beta-thalassemia major in Diyarbakir. Bone 2011;49:819-23.

Rossi F, Perrotta S, Bellini G, Luongo L, Tortora C, Siniscalco D, et al. Iron overload causes osteoporosis in thalassemia major patients through interaction with transient receptor potential vanilloid type 1 (TRPV1) channels. Haematologica 2014;99:1876-84.

Perisano C, Marzetti E, Spinelli MS, Calla CA, Graci C, Maccauro G. Physiopathology of bone modifications in beta-thalassemia. Anemia 2012;2012:320737.

Merchant R, Udani A, Puri V, Dâ€™Cruz V, Patkar D, Karkera A. Evaluation of osteopathy in thalassemia by bone mineral densitometry and biochemical indices. Indian J Pediatr 2010;77:987-91.

Mohseni F, Mohajeri-Tehrani M, Larijani B, Hamidi Z. Bone density changes in thalassaemic patients with age and time period. HK J Paediatr 2016;21:257-61.

Amir MA, Abdeen HM, Ezzat GM, Ghanem AA, Hassan AA. Predictors of osteopathy among adult patients with thalassemia major. Asian J Med Health 2017;5:1-9.

Izadyar S, Fazeli M, Izadyar M, Salamati P, Gholamrezanezhad A. Bone mineral density in adult patients with major thalassaemia: Our experience and a brief review of the literature. Endokrynol Pol 2012;63:264-9.

Nesheli HM, Farahanian E. Relation between bone mineral density and serum ferritin levels in patients with thalassemia major. Caspian J Pediatr 2016;2:158-63.

De Sanctis V, Soliman AT, Elsedfy H, Yassin M, Canatan D, Kilinc Y, et al. Osteoporosis in thalassemia major: An update and the I-CET 2013 recommendations for surveillance and treatment. Pediatr Endocrinol Rev 2013;11:167-80.

Shah S. Assessment of serum calcium and phosphorus levels among transfusion-dependent beta thalassemia major patients on chelation therapy. J Postgrad Med Inst 2015;29:168-71.

PirinÃ§Ã§ioÄŸlu1 AG, SÃ¶ker DG. Parathyroid functions in thalassemia major patients. Ann Clin Endocrinol Metab 2017;1:15-9.

Chern JP, Lin KH. Hypoparathyroidism in transfusion-dependent patients with beta-thalassemia. J Pediatr Hematol Oncol 2002;24:291-3.

De Sanctis V, Vullo C, Bagni B, Chiccoli L. Hypoparathyroidism in beta-thalassemia major. Clinical and laboratory observations in 24 patients. Acta Haematol 1992;88:105-8.

Soliman A, De Sanctis V, Yassin M. Vitamin D status in thalassemia major: An update. Mediterr J Hematol Infect Dis 2013;5:e2013057.

Akhouri MR, Neha D. Assessment of Vitamin D status and growth parameters in thalassemia major patients. J Dent Med Sci 2017;16:57-60.