Bone resorption is increased in young adults with thalassaemia major

Bone disease in patients with thalassaemia major is a multifactorial and st ill poorly understood process. The present study evaluated 45 thalassaemic patients using dual X-ray absorptiometry at three sites (lumbar spine, head of femur and forearm) to assess bone mineral density, in parallel with a s eries of biochemical markers to measure bone formation and bone resorption. To identify possible interfering factors, our patients were grouped accord ing to whether or not they needed transfusion therapy; the presence of hypo gonadism was also considered. Our results showed that patients on regular t ransfusions had a markedly low bone mineral density in contrast to those no t requiring blood support and that this finding was more pronounced in the hypogonadic group, irrespectively of sex. The decrease of bone mineral dens ity values was more prominent in the forearm, thus making this site particu larly interesting for such studies. Bone formation, as evidenced by the lev els of serum alkaline phosphatase and osteocalcin, did not appear to be imp aired, while bone resorption was grossly increased in all patient groups. T he latter process was clearly evident using the recently introduced measure ment of the urinary N-terminal peptides of collagen type I, the sensitivity of which has already been established in other groups of osteoporotic pati ents. Our conclusion is that, in spite of the severe bone destruction that occurs in thalassaemia major, the fact that bone formation remains intact c alls for a more intensive treatment comprising hormonal replacement, bispho sphonates and other agents.