Hematology Research Centre, Nemazee Hospital, Shiraz University of Medical Sciences, 7193635899, Shiraz, Iran.
Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Bone Miner Metab. 2019 Nov;37(6):996-1003. doi: 10.1007/s00774-019-01003-1. Epub 2019 Apr 11.
Thalassemia, as the most prevalent genetic blood disorder, has many associated comorbidities including low bone mass. We studied the comparative effectiveness of alendronate (AL) and zoledronic acid (ZOL) on bone mass improvement in transfusion-dependent thalassemia (TDT) patients a year after treatment. Three hundred seventy-five TDT patients with low bone mass were enrolled in this study. After a year of treatment with either AL or ZOL, a second bone mineral density (BMD) test was ordered to compare the effectiveness of the two aforementioned drugs. Body mass index (BMI), physical activity, sun exposure, and biochemical laboratory data were also considered as associated factors in this study. The BMD test of both groups was almost the same at the baseline and it increased comparably after a year of treatment with AL and ZOL. However, there was a significant difference in lumbar spine BMD delta Z score between both groups of female patients. ZOL was more effective in increasing the lumbar spine BMD of female patients. The choice of bisphosphonates therapy (oral versus parenteral) should be individually selected by considering patient's preference, compliance and the physician's decision. Given the longer administration interval, and TDT patients' compliance issue, it is justified to recommend ZOL as the drug of choice for patients suffering from low bone mass.
地中海贫血是最常见的遗传性血液疾病，有许多相关的合并症，包括低骨量。我们研究了阿仑膦酸钠（AL）和唑来膦酸（ZOL）在输血依赖型地中海贫血（TDT）患者治疗 1 年后对改善骨量的比较效果。本研究纳入了 375 名患有低骨量的 TDT 患者。在接受 AL 或 ZOL 治疗 1 年后，进行了第二次骨密度（BMD）检测，以比较这两种药物的疗效。体重指数（BMI）、身体活动、阳光暴露和生化实验室数据也被认为是本研究中的相关因素。两组的 BMD 检测在基线时几乎相同，在接受 AL 和 ZOL 治疗 1 年后，BMD 增加相当。然而，两组女性患者的腰椎 BMD 差值 Z 评分存在显著差异。ZOL 更有效地增加了女性患者的腰椎 BMD。双膦酸盐治疗（口服与静脉）的选择应根据患者的偏好、依从性和医生的决定进行个体化选择。鉴于较长的给药间隔以及 TDT 患者的依从性问题，推荐 ZOL 作为低骨量患者的首选药物是合理的。
