Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Arch Osteoporos. 2020 Sep 14;15(1):143. doi: 10.1007/s11657-020-00819-z.
Iron overload, a state with excessive iron storage in the body, is a common complication in thalassemia patients which leads to multiple organ dysfunctions including the bone. Iron overload-induced bone disease is one of the most common and severe complications of thalassemia including osteoporosis. Currently, osteoporosis is still frequently found in thalassemia even with widely available iron chelation therapy.
Relevant publications published before December 2019 in PubMed database were reviewed. Both pre-clinical studies and clinical trials were obtained using iron overload, thalassemia, osteoporosis, osteoblast, and osteoclast as keywords.
Increased ROS production is a hallmark of iron overload-induced impaired bone remodeling. At the cellular level, oxidative stress affects bone remodeling by both osteoblast inhibition and osteoclast activation via many signaling pathways. In thalassemia patients, it has been shown that bone resorption was increased while bone formation was concurrently reduced.
In this review, reports on the cellular mechanisms of iron overload-associated bone remodeling are comprehensively summarized and presented to provide current understanding this pathological condition. Moreover, current treatments and potential interventions for attenuating bone remodeling in iron overload are also summarized to pave ways for the future discoveries of novel agents that alleviate this condition.
铁过载是一种体内铁储存过多的状态，是地中海贫血患者的常见并发症，可导致包括骨骼在内的多个器官功能障碍。铁过载引起的骨骼疾病是地中海贫血最常见和最严重的并发症之一，包括骨质疏松症。目前，即使广泛应用铁螯合治疗，地中海贫血仍常伴有骨质疏松症。
检索了 2019 年 12 月前在 PubMed 数据库中发表的相关文献。使用铁过载、地中海贫血、骨质疏松症、成骨细胞和破骨细胞作为关键词，获得了临床前研究和临床试验。
ROS 产生增加是铁过载引起的骨重塑受损的标志。在细胞水平上，氧化应激通过许多信号通路抑制成骨细胞和激活破骨细胞，影响骨重塑。在地中海贫血患者中，已表明骨吸收增加，同时骨形成减少。
在这篇综述中，全面总结了铁过载相关骨重塑的细胞机制报告，以提供对这种病理状况的当前认识。此外，还总结了目前减轻铁过载骨重塑的治疗方法和潜在干预措施，为发现缓解这种情况的新型药物铺平了道路。
