Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Expert Rev Hematol. 2019 Nov;12(11):997-1003. doi: 10.1080/17474086.2019.1662721. Epub 2019 Sep 5.
: Iron overload might lead to bone loss in transfusion-dependent beta-thalassemia (TDT) patients. To investigate the role of iron chelation therapy (ICT) on bone mineral density (BMD) of TDT patients suffering from iron overload, the authors compared the efficacy of five different iron chelation regimens through assessing serum ferritin and BMD.: In 256 consecutive TDT patients, BMD was measured by dual-energy X-ray absorptiometry in lumbar spine and femoral neck regions. Treatment outcome of five iron chelation regimens including Deferoxamine (DFO), Deferiprone (DFP), Deferasirox (DFX), and combination therapy was evaluated to compare the mean differences of serum ferritin and BMD indices pre- and post-treatment during 12-months follow-up period.: No significant difference was observed in DXA characteristics and serum ferritin level changes between ICT groups, but combination of DFO and DFX had the best outcome in improving bone mass through assessing each group individually.: Combination therapy with DFX and DFO had the highest impact on reducing serum ferritin, however insignificant, and improving bone loss in both lumbar spine and femoral neck in comparison with other regimens. A randomized prospective clinical trial is advised to accurately assess the efficacy of iron chelation regimens on BMD measurements of TDT patients.
铁过载可能导致输血依赖型β地中海贫血（TDT）患者的骨质流失。为了研究铁螯合疗法（ICT）对铁过载 TDT 患者骨密度（BMD）的作用，作者通过评估血清铁蛋白和 BMD，比较了五种不同铁螯合方案的疗效。在 256 例连续 TDT 患者中，通过双能 X 射线吸收法测量腰椎和股骨颈区域的 BMD。评估了包括去铁胺（DFO）、地拉罗司（DFX）和联合治疗在内的五种铁螯合方案的治疗效果，以比较 12 个月随访期间治疗前后血清铁蛋白和 BMD 指标的平均差异。
在 DXA 特征和血清铁蛋白水平变化方面，ICT 组之间未观察到显著差异，但单独评估每个组时，DFO 和 DFX 的联合治疗在改善骨量方面具有最佳效果。与其他方案相比，DFX 和 DFO 的联合治疗对降低血清铁蛋白（尽管无统计学意义）和改善腰椎和股骨颈的骨质流失影响最大。建议进行随机前瞻性临床试验，以准确评估铁螯合方案对 TDT 患者 BMD 测量的疗效。
