Effects of hormonal replacement therapy on bone metabolism in young adultswith beta-thalassemia major

The aim of our cross-sectional study was to evaluate the effects of hormona l replacement therapy (HRT) on a population of young thalassemics in order to understand better the role of hypogonadism in the balance of bone metabo lism. Markers of bone turnover and bone mineral density (BMD) were measured in 40 young patients (mean age 19.8 +/- 4.5 years) with betathalassemia ma jor: 20 subjects were biochemically eugonadal, since they were undergoing H RT (group A, treated patients), and 20 were hypogonadic, having suspended H RT (group B, untreated patients). We also examined 20 healthy control subje cts (group C) matched for age, anthropometric features and sex to the study groups. Our study shows that young thalassemic patients exhibit a signific ant loss of cortical and trabecular bone [aBMD L2-L4: 0.886 +/- 0.052 g/cm( 2) (group), 0.726 +/- 0.040 g/cm(2) (group B), 1.083 +/- 0.090 g/cm(2) (gro up C); aBMD femoral neck: 0.890 +/- 0.071 g/cm(2) (group A), 0.700 +/- 0.06 5 g/cm(2) (group B), 0.934 +/- 0.076 g/cm(2) (group C)] Osteoporosis is onl y observed at the lumbar level in treated thalassemic patients, while in un treated patients it involves the femoral neck also. Done turnover in thalas semic patients is higher in the resorptive phase, than in the neoformation phase and this is more marked in hypogonadicuntreated patients. In conclusi on, our data demonstrate the important role played by hypogonadism in the d evelopment and deterioration of osteopenia/osteoporosis in thalassemia majo r. Consequently, sex hormone replacement therapy represents an appropriate tool in the prevention and treatment of osteoporosis in thalassemics, proba bly together with bisphosphonates in cases with severely increased bone res orption.