IMEMR
66.92
Volume 5, Issue 3 (2024)                   J Clinic Care Skill 2024, 5(3): 165-171 | Back to browse issues page

Print XML PDF HTML Full-Text (HTML)

Ethics code: IR.IUMS.FMD.REC.1400.557


History

How to cite this article
Ansari Damavandi S, Amirkashani D, Tagrian Isfahani M. The Effect of Bisphosphonate with Testosterone on Bone Mineral Density in Male Patients with Thalassemia Major. J Clinic Care Skill 2024; 5 (3) :165-171
URL: http://jccs.yums.ac.ir/article-1-252-en.html
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Rights and permissions
1- “Department of Pediatric Hematology & Oncology, School of Medicine” and “Aliasghar Children’s Hospital”, Iran University of Medical Sciences, Tehran, Iran
2- “Department of Pediatric Metabolic & Endocrine Disease, School of Medicine” and “Aliasghar Children’s Hospital”, Iran University of Medical Sciences, Tehran, Iran
3- “Department of Pediatric Hematology & Oncology, School of Medicine” and “Hakim Children’s Hospital”, Tehran University of Medical Sciences, Tehran, Iran
* Corresponding Author Address: Hakim Children’s Hospital, Shahid Omrani Boulevard, Imam Ali Square, Yaftabad, Tehran, Iran. Postal Code: 1375946316 (mtagrian@yahoo.com)
Abstract   (757 Views)
Aims: Thalassemia major patients are at a heightened risk for osteopenia and osteoporosis, influenced by factors including hypogonadism. However, treatment with steroids alone has not consistently yielded substantial improvements in bone density indicators. This study aimed to evaluate the impact of bisphosphonate therapy, both with and without testosterone, on bone density indices in male patients with thalassemia major.
Materials & Methods: This quasi-experimental study included 40 male patients with thalassemia major, selected through convenience sampling, and divided into four groups: 1) a hypogonadism group receiving testosterone and alendronate (HTA group), 2) a hypogonadism group receiving testosterone alone (HT group), 3) a non-hypogonadism group treated with alendronate (NHA group), and 4) a hypogonadism group that declined any treatment (H group). Bone density was evaluated using Bone Mineral Densitometry via Dual-energy X-ray absorptiometry, both before and one year after the interventions, with results compared across the groups. Data analysis was conducted using SPSS version 24, with a significance level set at p<0.05.
Findings: Thirty-eight participants, with a mean age of 22.46 ± 4.64 years, completed the study. Post-intervention results showed significant improvements in Lumbar Z score (p=0.001), Hip Z score (p=0.001), and Radius Z score (p=0.005) across the four groups. One year after intervention, the HTA group demonstrated greater improvements in bone mineral density compared to the NHA and HT groups.
Conclusion: Combining bisphosphonates with testosterone in thalassemia patients with hypogonadism enhances bone density more effectively than treatment with testosterone or bisphosphonates alone.
Keywords:

References
1. Mirzaa G, Graham JM, Keppler-Noreuil K. PIK3CA-related overgrowth spectrum. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, et al, editors. GeneReviews. Seattle: University of Washington; 2013. [Link]
2. Gaudio A, Morabito N, Catalano A, Rapisarda R, Xourafa A, Lasco A. Pathogenesis of thalassemia major-associated osteoporosis: A review with insights from clinical experience. J Clin Res Pediatr Endocrinol. 2019;11(2):110-7. [Link] [DOI:10.4274/jcrpe.galenos.2018.2018.0074]
3. Stefanopoulos D, Papaioannou NA, Papavassiliou AG, Mastorakos G, Vryonidou A, Michou A, et al. A contemporary therapeutic approach to bone disease in beta-thalassemia-a review. J Frailty Sarcopenia Falls. 2018;3(1):13-25. [Link] [DOI:10.22540/JFSF-03-013]
4. Saki N, Abroun S, Salari F, Rahim F, Shahjahani M, Javad MA. Molecular aspects of bone resorption in β-thalassemia major. Cell J. 2015;17(2):193-200. [Link]
5. Soliman AT, De Sanctis V, Elalaily R, Yassin M. Insulin-like growth factor-I and factors affecting it in thalassemia major. Indian J Endocrinol Metab. 2015;19(2):245-51. [Link] [DOI:10.4103/2230-8210.131750]
6. Wong P, Fuller PJ, Gillespie MT, Kartsogiannis V, Kerr PG, Doery JC, et al. Thalassemia bone disease: A 19‐year longitudinal analysis. J Bone Miner Res. 2014;29(11):2468-73. [Link] [DOI:10.1002/jbmr.2266]
7. 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(4):264-9. [Link]
8. Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5:11. [Link] [DOI:10.1186/1750-1172-5-11]
9. Mohajeri-Tehrani MR, Darvishian N, Arab F, Salemkar S, Mohseni F, Larijani B, et al. The role of using different reference population in the prevalence of low BMD in the thalassemia patients. J Diabetes Metab Disord. 2019;19(1):431-5. [Link] [DOI:10.1007/s40200-019-00455-6]
10. Yassin MA, Rahman MOA, Hamad AA, Poil AR, Abdelrazek MT, Hussein RM, et al. Denosumab versus zoledronic acid for patients with beta-thalassemia major-induced osteoporosis. Medicine. 2020;99(51):e23637. [Link] [DOI:10.1097/MD.0000000000023637]
11. Lee SLK, Wong RSM, Li CK, Leung WK. Prevalence and risk factors of fractures in transfusion dependent thalassemia-A Hong Kong Chinese population cohort. Endocrinol Diabetes Metab. 2022;5(4):e340. [Link] [DOI:10.1002/edm2.340]
12. Naithani R, Seth T, Tandon N, Chandra J, Choudhry V, Pati H, et al. Zoledronic acid for treatment of Low bone mineral density in patients with Beta thalassemia major. Indian J Hematol Blood Transfus. 2018;34(4):648-52. [Link] [DOI:10.1007/s12288-018-0953-x]
13. Vidal A, Dhakal C. Association of beta‐thalassaemia and hypogonadotropic hypogonadism. Case Rep Obstet Gynecol. 2022;2022:4655249. [Link] [DOI:10.1155/2022/4655249]
14. Poggi M, Samperi I, Mattia L, Di Rocco A, Iorio C, Monti S, et al. New insights and methods in the approach to thalassemia major: The lesson from the case of adrenal insufficiency. Front Mol Biosci. 2020;6:162. [Link] [DOI:10.3389/fmolb.2019.00162]
15. De Sanctis V, Soliman AT, Yassin MA, Di Maio S, Daar S, Elsedfy H, et al. Hypogonadism in male thalassemia major patients: Pathophysiology, diagnosis and treatment. Acta Biomed. 2018;89(Suppl 2):6-12. [Link]
16. Dede A, Trovas G, Chronopoulos E, Triantafyllopoulos I, Dontas I, Papaioannou N, et al. Thalassemia-associated osteoporosis: A systematic review on treatment and brief overview of the disease. Osteoporos Int. 2016;27(12):3409-25. [Link] [DOI:10.1007/s00198-016-3719-z]
17. Bhardwaj A, Swe KMM, Sinha NK. Treatment for osteoporosis in people with beta‐thalassaemia. Cochrane Database Syst Rev. 2023;5(5):CD010429. [Link] [DOI:10.1002/14651858.CD010429.pub3]
18. Piriyakhuntorn P, Tantiworawit A, Phimphilai M, Srichairatanakool S, Teeyasoontranon W, Rattanathammethee T, et al. The efficacy of alendronate for the treatment of thalassemia-associated osteoporosis: A randomized controlled trial. Front Endocrinol. 2023;14:1178761. [Link] [DOI:10.3389/fendo.2023.1178761]
19. Amin S, Zhang Y, Sawin CT, Evans SR, Hannan MT, Kiel DP, et al. Association of hypogonadism and estradiol levels with bone mineral density in elderly men from the Framingham study. Ann Intern Med. 2000;133(12):951-63. [Link] [DOI:10.7326/0003-4819-133-12-200012190-00010]
20. Meier C, Nguyen TV, Handelsman DJ, Schindler C, Kushnir MM, Rockwood AL, et al. Endogenous sex hormones and incident fracture risk in older men: The dubbo osteoporosis epidemiology study. Arch Intern Med. 2008;168(1):47-54. [Link] [DOI:10.1001/archinternmed.2007.2]
21. Golds G, Houdek D, Arnason T. Male hypogonadism and osteoporosis: The effects, clinical consequences, and treatment of testosterone deficiency in bone health. Int J Endocrinol. 2017;2017:4602129. [Link] [DOI:10.1155/2017/4602129]
22. Wong P, Fuller PJ, Gillespie MT, Kartsogiannis V, Milat F, Bowden DK, et al. The effect of gonadal status on body composition and bone mineral density in transfusion-dependent thalassemia. Osteoporos Int. 2014;25(2):597-604. [Link] [DOI:10.1007/s00198-013-2454-y]
23. Cima LN, Fica S. The use of anabolic therapy in patients with beta-thalassemia major-induced osteoporosis-review of the literature. FARMACIA. 2017;65(2):167-72. [Link]
24. Skordis N, Ioannou YS, Kyriakou A, Savva SC, Efstathiou E, Savvides I, et al. Effect of bisphosphonate treatment on bone mineral density in patients with thalassaemia major. Pediatr Endocrinol Rev. 2008;6 Suppl 1:144-8. [Link]
25. Giusti A. Bisphosphonates in the management of thalassemia-associated osteoporosis: A systematic review of randomised controlled trials. J Bone Miner Metab. 2014;32(6):606-15. [Link] [DOI:10.1007/s00774-014-0584-8]
26. Tsartsalis AN, Lambrou GI, Tsartsalis D, Savvidis C, Karantza M, Terpos E, et al. The role of biphosphonates in the management of thalassemia-induced osteoporosis: A systematic review and meta-analysis. Hormones. 2018;17(2):153-66. [Link] [DOI:10.1007/s42000-018-0019-3]
27. Harada A, Ito S, Matsui Y, Sakai Y, Takemura M, Tokuda H, et al. Effect of alendronate on muscle mass: Investigation in patients with osteoporosis. Osteoporos Sarcopenia. 2015;1(1):53-8. [Link] [DOI:10.1016/j.afos.2015.07.005]
28. Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, et al. Alendronate for the treatment of osteoporosis in men. N Engl J Med. 2000;343(9):604-10. [Link] [DOI:10.1056/NEJM200008313430902]
29. Perifanis V, Vyzantiadis T, Vakalopoulou S, Tziomalos K, Garypidou V, Athanassiou‐Metaxa M, et al. Treatment of beta‐thalassaemia‐associated osteoporosis with zoledronic acid. Br J Haematol. 2004;125(1):91-2. [Link] [DOI:10.1111/j.1365-2141.2004.04871.x]