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Wu D, Shen S. Osteoporosis and associated risk factors in patients with severe hemophilia A: a case-control study from China. BMC Musculoskelet Disord 2023; 24:657. [PMID: 37592270 PMCID: PMC10433558 DOI: 10.1186/s12891-023-06795-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION People with hemophilia risk osteoporosis more than healthy people, which may be related to specific factors. METHODS This case-control study included 53 patients with severe hemophilia type A and 49 healthy participants. Dual-energy X-ray absorptiometry (DXA) was used to determine bone mineral density (BMD). Collected information on age, body mass index (BMI), number of joint arthropathies, functional independence score in hemophilia (FISH), bone turnover markers, antibodies, treatment modalities. Identified independent risk factors for osteoporosis. RESULTS The BMD of the femoral neck (0.80 g/cm2vs.0.97 g/cm2), ward's triangle (0.62 g/cm2vs.0.83 g/cm2), tuberosity (0.63 g/cm2vs.0.80 g/cm2) and hip (0.80 g/cm2vs.0.98 g/ cm2) in the case group were significantly lower than those in the control group, all of which were P < 0.001. However, there was no significant difference in the overall BMD of lumbar spine(L1-L4) (1.07 g / cm2vs. 1.11 g / cm2). The frequency of osteoporosis in the case group was 41.51%. BMI and FISH score were considered as independent risk factors for BMD decrease. CONCLUSION The BMD of patients with severe hemophilia A is much lower than that of healthy population, and this difference is mainly reflected in the hip. The clear influencing factors were low BMI and functional independence decrease. Osteoclast was active while osteoblast activity was not enhanced synchronously, which may be the pathological mechanism of BMD decrease.
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Affiliation(s)
- DongXiao Wu
- The First Clinical College of Zhejiang Chinese Medical University, The First Affiliated Hospital of Zhejiang Chinese Medical University, 548# BinWen Road, HangZhou, ZheJiang Province, People's Republic of China
| | - ShaoNing Shen
- The Second Affiliated Hospital of Zhejiang Chinese Medicine University, 318 # Chaowang Road, HangZhou, ZheJiang Province, People's Republic of China.
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2
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Alito A, Bellone F, Portaro S, Leonardi G, Cannavò V, Coppini F, Leonetti D, Catalano A, Squadrito G, Fenga D. Haemophilia and Fragility Fractures: From Pathogenesis to Multidisciplinary Approach. Int J Mol Sci 2023; 24:ijms24119395. [PMID: 37298347 DOI: 10.3390/ijms24119395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Haemophilia A (HA) and haemophilia B (HB) are X-linked inherited bleeding disorders caused by the absence or deficiency of coagulation factors VIII (FVIII) and IX (FIX), respectively. Recent advances in the development of effective treatments for haemophilia have led to a significant increase in life expectancy. As a result, the incidence of some comorbidities, including fragility fractures, has increased in people with haemophilia (PWH). The aim of our research was to perform a review of the literature investigating the pathogenesis and multidisciplinary management of fractures in PWH. The PubMed, Scopus and Cochrane Library databases were searched to identify original research articles, meta-analyses, and scientific reviews on fragility fractures in PWH. The mechanism underlying bone loss in PWH is multifactorial and includes recurrent joint bleeding, reduced physical activity with consequent reduction in mechanical load, nutritional deficiencies (particularly vitamin D), and FVIII and FIX deficiency. Pharmacological treatment of fractures in PWH includes antiresorptive, anabolic and dual action drugs. When conservative management is not possible, surgery is the preferred option, particularly in severe arthropathy, and rehabilitation is a key component in restoring function and maintaining mobility. Appropriate multidisciplinary fracture management and an adapted and tailored rehabilitation pathway are essential to improve the quality of life of PWH and prevent long-term complications. Further clinical trials are needed to improve the management of fractures in PWH.
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Simona Portaro
- Department of Physical and Rehabilitation Medicine, University Hospital "G. Martino", 98100 Messina, Italy
| | - Giulia Leonardi
- Department of Physical and Rehabilitation Medicine, University Hospital "G. Martino", 98100 Messina, Italy
| | - Vittorio Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Francesca Coppini
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. "G. Martino", 98100 Messina, Italy
| | - Danilo Leonetti
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. "G. Martino", 98100 Messina, Italy
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3
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Rodriguez-Merchan EC. Intra-articular injection of platelet-rich plasma in patients with hemophilia and painful knee joint cartilage degeneration. Expert Rev Hematol 2023:1-10. [PMID: 36609192 DOI: 10.1080/17474086.2023.2166922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Knee arthropathy causes pain to people with hemophilia (PWH). One of the current controversies is whether injections of intra-articular platelet-rich plasma (PRP) are effective in relieving the knee pain of PWH. AREAS COVERED A narrative literature review was conducted on the efficacy of PRP injections in the knees of PWH. EXPERT OPINION Intra-articular PRP knee injections are widely used in patients with knee osteoarthritis to relieve pain and delay total knee arthroplasty. Although numerous publications have supported the use of PRP in knee osteoarthritis, there is still major controversy regarding its true usefulness, given that a number of studies with a high degree of evidence have failed to show the efficacy of PRP. With respect to painful hemophilic arthropathy, the use of PRP injections is even more controversial, as there are only four publications on the subject supporting the use of PRP in hemophilia, all of them with a low degree of evidence. A publication with grade 1 evidence recommended against the use of PRP in hemophilic arthropathy because its efficacy has not been demonstrated. My opinion is that intra-articular PRP injections should not be used in hemophilia until there is more evidence of its benefits.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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4
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Lin X, Gao P, Zhang Q, Jiang Y, Wang O, Xia W, Li M. Pathogenesis and treatment of osteoporosis in patients with hemophilia. Arch Osteoporos 2023; 18:17. [PMID: 36598583 PMCID: PMC9813251 DOI: 10.1007/s11657-022-01203-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Hemophilia is a rare X-linked recessive inherited bleeding disorder caused by mutations of the genes encoding coagulation factor VIII (FVIII) or IX (FIX). Patients with hemophilia (PWH) often have a high risk of osteoporosis and fractures that is usually ignored. Herein, we review the underlying mechanisms of osteoporosis and the increased risk of fractures and their treatment in patients with FVIII or FIX deficiency. METHODS The PubMed, Web of Science, Embase, and Cochrane Library databases were searched to identify original research articles, meta-analyses, and scientific reviews on the mechanisms or treatment of osteoporosis in PWH. RESULTS The pathogenic mechanisms of osteoporosis in PWH are multifactorial and remain unclear. The available evidence shows that FVIII and FIX deficiency may directly affect bone metabolism by interfering with the RANK/RANKL/OPG pathway. Other potential mechanisms of osteoporosis in PWH include thrombin deficiency and the unloading and immobilization of bone, which will affect osteoblast and osteoclast activity by changing the cytokine profiles. The treatment of osteoporosis in PWH includes antiresorptive, anabolic, and dual-action drugs; weight-bearing exercise; fall prevention; and prophylactic coagulation factor replacement therapy. However, clinical studies of the efficacy of anti-osteoporotic agents in osteoporosis of PWH are urgently needed. CONCLUSION This review summarizes recent progress in research on the pathogenesis of osteoporosis in PWH and provides insights into potential treatment for osteoporosis in PWH.
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Affiliation(s)
- Xiaoyun Lin
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peng Gao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qian Zhang
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Jiang
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ou Wang
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weibo Xia
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mei Li
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Czajkowska S, Rupa-Matysek J, Wojtasińska E, Nijakowski K, Surdacka A, Gil L. The Profile of Markers of Bone Turnover, Inflammation and Extracellular Neutrophil Traps on Bone Mass in Haemophilia and the Development of Haemophilic Arthropathy. J Clin Med 2022; 11:jcm11164711. [PMID: 36012950 PMCID: PMC9410524 DOI: 10.3390/jcm11164711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of the study is to evaluate selected biomarkers of bone turnover, inflammation, neutrophil trap and factors predisposing haemophiliacs to bone loss, and to analyse their relationship with clinical features, treatment and complications. Methods: The levels of interleukin 6 (IL-6); citrullinated histone (CH3); osteocalcin (BGLAP); bone alkaline phosphatase (BALP); N-terminal procollagen type I propeptide (P1NP); and C-terminal collagen type I telopeptide (C1CP) were examined in 60 patients with haemophilia. Results: The cut-off value for BGLAP is 26.41 ng/mL, and 929.7 pg/mL for CH3. There is a statistically significant difference between BGLAP, BALP, C1CP and CH3 concentrations, depending on the prophylaxis used. The median concentration of BGLAP in patients taking the factor on demand is 28.0 ng/mL, BALP 322.5 U/L, C1CP 191.2 ng/mL and CH3 1114.4 pg/mL. In patients taking recombinant coagulation factor VIII/IX as prophylaxis of bleeding, the median BGLAP concentrations are 35.9 ng/mL, BALP 280.9 U/L, C1CP 161.6 ng/mL and CH3 952.5 pg/mL. BGLAP and BALP concentrations are dependent on the development of haemophilic arthropathic. Conclusions: The concentrations of selected markers of bone turnover and NETs may help to identify patients at particular risk of developing haemophilic arthropathy and bone metabolic turnover abnormalities.
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Affiliation(s)
- Sylwia Czajkowska
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
- Correspondence:
| | - Joanna Rupa-Matysek
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Ewelina Wojtasińska
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Kacper Nijakowski
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Anna Surdacka
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Lidia Gil
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
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Pain in Hemophilia: Unexplored Role of Oxidative Stress. Antioxidants (Basel) 2022; 11:antiox11061113. [PMID: 35740010 PMCID: PMC9220316 DOI: 10.3390/antiox11061113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
Hemophilia is the most common X-linked bleeding diathesis caused by the genetic deficiency of coagulation factors VIII or IX. Despite treatment advances and improvements in clinical management to prevent bleeding, management of acute and chronic pain remains to be established. Repeated bleeding of the joints leads to arthropathy, causing pain in hemophilia. However, mechanisms underlying the pathogenesis of pain in hemophilia remain underexamined. Herein, we describe the novel perspectives on the role for oxidative stress in the periphery and the central nervous system that may contribute to pain in hemophilia. Specifically, we cross examine preclinical and clinical studies that address the contribution of oxidative stress in hemophilia and related diseases that affect synovial tissue to induce acute and potentially chronic pain. This understanding would help provide potential treatable targets using antioxidants to ameliorate pain in hemophilia.
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7
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Patel GR, Saxena R, Aggarwal S, Mahapatra M. Evaluation of bone mineral density (BMD) and the effect of type of factor replacement therapy on BMD in children with hemophilia: A single-center observational study. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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8
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Risk Factors for Amputation in the Surgical Treatment of Hemophilic Osteoarthropathy: A 20-Year Single-Center Report. Pain Res Manag 2022; 2022:1512616. [PMID: 35386858 PMCID: PMC8979685 DOI: 10.1155/2022/1512616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 12/19/2022]
Abstract
Purpose Hemophilic osteoarthropathy (HO) is a common cause of spontaneous bleeding in hemophiliacs. Surgical procedures are necessary for patients with severe HO. As a last resort, amputation is sometimes needed to treat complex HO cases. This study aimed to review the existing records of patients who underwent amputations in HO surgical treatment, summarize the risk factors, and provide relevant references for surgeons. Methods We retrospectively reviewed the records of hemophilic patients received surgeries at Peking Union Medical College Hospital between 2000 and 2020. The amputation patients without neoplasm or acute trauma were screened out. Patient information was extracted from medical records. A literature retrieval of hemophilic amputation cases was conducted via PubMed. The risk factors of amputation were summarized and analyzed via descriptive statistics and Fisher's precision probability test. Results Four male hemophilia A patients out of 201 patients underwent lower limb amputation. The reasons of amputation contained severe pseudotumor with factor inhibitor and large bone defects, recurrent pathological fracture with pseudotumor, skin ulcer with chronic osteomyelitis, and pseudotumor with systematic infection. In cases reported in retrieved literature, severe pseudotumor with complications, bacterial infection and factor inhibitor were common factors. Discussion. As the first study on amputations in HO patients, we found that severe hemophilic pseudotumor, chronic bacterial infection, and coagulation factor inhibitor was potential risk factors for amputation. Sufficient factor replacement therapy is fundamental in the prevention of amputation. The early diagnosis and specially designed surgical techniques could improve the rate of limb salvage.
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9
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Gebetsberger J, Schirmer M, Wurzer WJ, Streif W. Low Bone Mineral Density in Hemophiliacs. Front Med (Lausanne) 2022; 9:794456. [PMID: 35186990 PMCID: PMC8849249 DOI: 10.3389/fmed.2022.794456] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Objective To review the current knowledge on bone health in patients with hemophilia A and the underlying pathogenetic mechanisms. Data Sources Original research articles, meta-analyses, and scientific reviews. Data Synthesis Already in childhood, patients with hemophilia A are prone to low bone mineral density, leading to osteopenia and/or osteoporosis. Initially associated with the life style of hemophilia, today we are faced with accumulating evidence that coagulation factor VIII is involved directly or indirectly in bone physiology. Conclusion Understanding the role of factor VIII and the mechanisms of decreased bone mineral density in hemophilia A is critically important, especially as non-factor replacement therapies are available, and treatment decisions potentially impact bone health.
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Affiliation(s)
| | - Michael Schirmer
- Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Werner Streif
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
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10
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Pergantou H, Papakonstantinou O, Xafaki P, Athanasopoulou H, Balanika A, Kattamis A, Doulgeraki A. Uncoupling of Bone Turnover may Compromise Skeletal Health of Young Patients With Haemophilia A. J Clin Densitom 2022; 25:89-96. [PMID: 34384686 DOI: 10.1016/j.jocd.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
There is evidence that bone mass is decreased and bone metabolism is dysregulated in children with haemophilia (CWH). The objective of this study was to investigate the impact of haemophilia on skeletal health in children, with regards to bone mineral density (BMD) and metabolic bone profile. This study included 51 male CWH A. Dual-energy X-ray absorptiometry (DXA) was performed to assess BMD in lumbar spine (LS) and total body less head (TBLH) and Z-scores were calculated (low BMD Z-score<-2, low-normal BMD Z-score between -1 and -2). Serum levels of osteocalcin (OC), procollagen type I C-terminal propeptide (PICP), bone alkaline phosphatase (bALP), bone tartrate-resistant acid phosphatase 5b (TRAP5b), vitamin D, parathormone (PTH), urinary calcium/creatinine (uCa/uCr) and urine deoxypyridinoline/creatinine (uDPD/uCr) were measured. Mean BMD Z-scores were lower than predicted at both sites of measurement. More specifically, 10% of CWH A had low and 20% low-normal BMD Z-scores in LS, whereas 9.1% had low-normal TBLH BMD Z-scores and there were no patients with low BMD Z-scores at this site of measurement. 36.7% of CWH had low vitamin D levels and 19.6% had a history of fracture. Also, patients with haemophilia had lower OC and higher uDPD/uCr levels while OC positively correlated to BMD Z-scores and uDPD/uCr negatively correlated to BMD Z-scores at both sites. No statistically significant differences were observed with regards to mode of treatment, number of haemorrhages and the presence of target-joints. CWH A had decreased BMD Z-scores at both sites with an uncoupling of bone turnover LS BMD seemed to be more affected than TBLH BMD.
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Affiliation(s)
- Helen Pergantou
- Haemophilia Centre/Haemostasis and Thrombosis Unit, Aghia Sophia Children's Hospital, Athens, Greece.
| | | | - Panagiota Xafaki
- Haemophilia Centre/Haemostasis and Thrombosis Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Helen Athanasopoulou
- Department of Bone and Mineral Metabolism, Institute of Child Health, Αthens, Greece
| | - Alexia Balanika
- Second Radiology Department, "Attikon" University Hospital, Athens, Greece
| | - Antonis Kattamis
- First Paediatric Department - Athens Medical School, Aghia Sophia Children's Hospital, Athens- Greece
| | - Artemis Doulgeraki
- Department of Bone and Mineral Metabolism, Institute of Child Health, Αthens, Greece
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Larson EA, Larson HJ, Taylor JA, Klein RF. Deletion of Coagulation Factor IX Compromises Bone Mass and Strength: Murine Model of Hemophilia B (Christmas Disease). Calcif Tissue Int 2021; 109:577-585. [PMID: 34117910 PMCID: PMC8484143 DOI: 10.1007/s00223-021-00872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 11/04/2022]
Abstract
Osteopenia and osteoporosis have increasingly become a recognized morbidity in those persons with hemophilia (PwH) receiving inadequate prophylactic clotting factor replacement. Animal models can control or eliminate genetic and environmental factors and allow for invasive testing not clinically permissible. Here, we describe the skeletal phenotype of juvenile and adult male mice with a genetically engineered deficiency in coagulation factor IX (FIX KO). Although the somatic growth of FIX KO mice matched that of their wild-type (WT) littermates at 10 and 20 weeks of age, the FIX KO mice displayed reduced bone mineral density (BMD), reduced cortical and cancellous bone mass, and diminished whole bone fracture resistance. These findings coupled with parallel observations in a murine model of hemophilia A (FVIII deficiency) point to an effector downstream of the coagulation cascade that is necessary for normal skeletal development. Further study of potential mechanisms underlying the bone disease observed in rare clotting factor deficiency syndromes may lead to new diagnostic and therapeutic insights for metabolic bone diseases in general.
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Affiliation(s)
- Emily A Larson
- Portland Veterans Affairs Research Foundation, Portland, OR, USA
| | - Hillary J Larson
- Portland Veterans Affairs Research Foundation, Portland, OR, USA
| | - Jason A Taylor
- The Hemophilia Center, Oregon Health & Science University, Portland, OR, USA
| | - Robert F Klein
- Medical Research Service, Portland Veterans Affairs Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
- Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA.
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12
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Zhu H, Meng Y, Tong P, Zhang S. Pathological mechanism of joint destruction in haemophilic arthropathy. Mol Biol Rep 2020; 48:969-974. [PMID: 33289909 DOI: 10.1007/s11033-020-06052-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
Haemophilic arthropathy (HA), caused by intra-articular haemorrhage, is one of the most common complications in patients with haemophilia. Factor replacement therapy provides missing coagulation factors to prevent children with haemophilia from joint bleeding and decreases their risk for HA. However, haemophilia patients in developing countries are still suffering from HA due to insufficient replacement therapy. Symptoms such as pain and activity limitations caused by HA seriously affect the functional abilities and quality of life of patients with HA, causing a high disability rate in the haemophilia cohort. The pathological mechanism of HA is complicated because the whole pathological mainly involves hypertrophic synovitis, osteopenia, cartilage and bone destruction, and these pathological changes occur in parallel and interact with each other. Inflammation plays an important role in the whole complex pathological process, and iron, cytokines, growth factors and other factors are involved. This review summarizes the pathological mechanism of HA to provide background for clinical and basic research.
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Affiliation(s)
- Haijia Zhu
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Yilin Meng
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Peijian Tong
- Department of Orthopedic Surgery, The First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Shanxing Zhang
- Department of Orthopedic Surgery, The First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
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13
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Goldscheitter G, Recht M, Sochacki P, Manco-Johnson M, Taylor JA. Biomarkers of bone disease in persons with haemophilia. Haemophilia 2020; 27:149-155. [PMID: 32856388 DOI: 10.1111/hae.13986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Persons with haemophilia (PwH) have abnormally low bone density and increased risk of fractures. We previously demonstrated decreased skeletal health in factor VIII (FVIII)-deficient mice. Thus, we hypothesized factor deficiency is an independent risk factor for decreased skeletal health. AIM We seek to identify differences in bone-related cytokine expression among PwH and healthy controls. METHODS We evaluated plasma samples from 79 participants with severe FVIII deficiency and 51 age-matched healthy controls. Plasma samples were assessed for RANKL and OPG, cytokines that regulate bone metabolism, and CTX-1, a biomarker for bone resorption, as well as 10 bone-related cytokines. RESULTS CTX-1 is higher among samples from FVIII-deficient participants compared to controls (P < .01) but not among participants with recent factor use (within 24 hours of sample collection) (P = .21). Among PwH greater than 16 years of age (PwH ≥ 16), OPG is increased with recent factor use (P < .01) but not without (P = .34). Lower levels of TNF-α (P < .01), interleukin (IL)-12 (P < .01) and IL-10 (P < .001) were found among samples from PwH. Controlling for subject age, IL-12 and IL-10 levels are lower in PwH ≥ 16 (P < .01, P < .001) but not PwH under 16 (PwH < 16) (P > .05). Levels of TNF-α were lower among PwH < 16 only (P < .05). These differences are not observed in participants with recent factor use. CONCLUSIONS In PwH, markers of bone metabolism and circulating cytokine levels are abnormal. Recent factor use reverses many of these differences suggesting FVIII replacement ameliorates this pathology. This study suggests bone disease present in PwH is intrinsic to FVIII deficiency.
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Affiliation(s)
| | - Michael Recht
- The Hemophilia Center, Oregon Health & Science University, Portland, OR, USA
| | | | - Marilyn Manco-Johnson
- Hemophilia and Thrombosis Center, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Jason A Taylor
- Portland Veterans Affairs Medical Center, Portland, OR, USA.,The Hemophilia Center, Oregon Health & Science University, Portland, OR, USA
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14
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Linari S, Melchiorre D, Pieri L, Tofani L, Fanelli A, Brogi M, Castaman G. Low bone mass and hypovitaminosis D in haemophilia: A single-centre study in patients with severe and moderate haemophilia A and B. Haemophilia 2020; 26:898-906. [PMID: 32842167 DOI: 10.1111/hae.14127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Haemophilia (H) is frequently associated with a multifactorial reduction in bone mineral density (BDM), but little is known about possible differences between HA and HB according to their severity. AIM To evaluate the association between low bone mineral density (BMD), 25-hydroxyvitamin D [25(OH)D] concentrations and bone turnover markers in patients with HA and HB younger or older than 50 years. METHODS In 78 patients <50 years and 33 patients >50 years with severe (S) or moderate (M) HA and HB, BMD was measured by dual-energy X-ray absorptiometry at femoral neck (FN) and lumbar spine and then correlated to annual bleeding rate (ABR), World Federation of Haemophilia orthopaedic joint scale (WFH score), 25(OH)D concentrations, parathyroid hormone (PTH), amino-terminal telopeptide of type 1 collagen (NTx), urinary pyridinolines, osteocalcin and bone-specific alkaline phosphatase. RESULTS Overall, a high prevalence of hypovitaminosis D was diagnosed. In patients <50 years, low FN-BMD was significantly more frequent in HA than in HB, while PTH, pyridinolines, ABR and WFH score were associated with H type and severity. In patients >50 years, similarly low FN-BMD was observed in HA and HB, while ABR and WFH score were associated with H type and severity, being milder in HB. CONCLUSIONS Low bone mass is a frequent comorbidity in haemophilic patients of all ages, apart from those with MHB. Clinical and laboratory assessments confirm a higher bone impairment and faster bone resorption in HA compared with HB. Looking at H type and severity, MHB seems to have a normal bone metabolism and a less severe disease.
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Affiliation(s)
- Silvia Linari
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | - Daniela Melchiorre
- Department of Experimental, Clinical Medicine and Rheumatology, Careggi University Hospital, Firenze, Italy
| | - Lisa Pieri
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | - Lorenzo Tofani
- Department of Experimental, Clinical Medicine and Rheumatology, Careggi University Hospital, Firenze, Italy
| | | | - Marco Brogi
- Central Laboratory, Careggi University Hospital, Firenze, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
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15
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Reduced bone formation in males and increased bone resorption in females drive bone loss in hemophilia A mice. Blood Adv 2020; 3:288-300. [PMID: 30700417 DOI: 10.1182/bloodadvances.2018027557] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/07/2019] [Indexed: 11/20/2022] Open
Abstract
Hemophilia A (HA), a rare X-linked recessive genetic disorder caused by insufficient blood clotting factor VIII, leaves affected individuals susceptible to spontaneous and traumatic hemorrhage. Although males generally exhibit severe symptoms, due to variable X inactivation, females can also be severely impacted. Osteoporosis is a disease of the skeleton predisposing patients to fragility fracture, a cause of significant morbidity and mortality and a common comorbidity in HA. Because the causes of osteoporosis in HA are unclear and in humans confounded by other traditional risk factors for bone loss, in this study, we phenotyped the skeletons of F8 total knockout (F8 TKO) mice, an animal model of severe HA. We found that trabecular bone accretion in the axial and appendicular skeletons of male F8 TKO mice lagged significantly between 2 and 6 months of age, with more modest cortical bone decline. By contrast, in female mice, diminished bone accretion was mostly limited to the cortical compartment. Interestingly, bone loss was associated with a decline in bone formation in male mice but increased bone resorption in female mice, a possible result of sex steroid insufficiency. In conclusion, our studies reveal a sexual dimorphism in the mechanism driving bone loss in male and female F8 TKO mice, preventing attainment of peak bone mass and strength. If validated in humans, therapies aimed at promoting bone formation in males but suppressing bone resorption in females may be indicated to facilitate attainment of peak mass in children with HA to reduce the risk for fracture later in life.
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16
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Sahin S, Sadri S, Baslar Z, Ar MC. Osteoporosis in Patients With Hemophilia: Single-Center Results From a Middle-Income Country. Clin Appl Thromb Hemost 2020; 25:1076029619861689. [PMID: 31282181 PMCID: PMC6714950 DOI: 10.1177/1076029619861689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Increased number of patients with hemophilia have been identified to have osteoporosis at early ages. Low bone mineral density in the setting of hemophilia has been associated with decreased mobility, sedentary life style, on demand treatment or delayed prophylaxis, low body weight and viral infections. The aim of this study was to investigate the impact of hemophilia on bone health of adult patients living in a middle income country. A total of 61 adult patients with hemophilia who were followed at the Hematology Department of Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa were consecutively included in this study. Bone health of the patients was assessed using the bone mineral density (BMD) and vitamin D levels. Z and t scores are used for evaluation of BMD in patients with hemophilia aged < 50 and ≥ 50 years, respectively. Information on treatment and co-morbidities including viral diseases were obtained from the medical files of the recruited patients. Bone mineral density was found normal in 30, and low in 29 patients. Vitamin D levels were below 20 ng/ml in 46 patients. No significant relationship was found between the severity of hemophilia and bone density. Vitamin D levels were significantly lower in patients who had a history of joint intervention. Neither annual bleeding rate nor the treatment modality (on demand versus prophylaxis) were associated with the bone mineral density and vitamin D levels. Annual factor consumption was higher in patients whose bone mineral densities was low both in femoral and lumbar regions. The results of this study depicting the situation of adult hemophilia population from a middle income country show that bone mineral density and vitamin D levels were decreased in a considerable amount of patients at early ages.
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Affiliation(s)
- Serdar Sahin
- 1 Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sevil Sadri
- 2 Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Zafer Baslar
- 3 Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muhlis Cem Ar
- 3 Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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17
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Gamal Andrawes N, Hashem Fayek M, Salah El-Din N, Atef Mostafa R. Effect of low-dose factor VIII prophylaxis therapy on bone mineral density and 25(OH) vitamin D level in children with severe haemophilia A. Haemophilia 2019; 26:325-332. [PMID: 31884718 DOI: 10.1111/hae.13917] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Decreased bone mineral density (BMD) is a significant morbidity in haemophilia. Vitamin D is important for the bone health of people with haemophilia. Regular factor VIII prophylaxis can prevent bleeding and arthropathy. AIM To determine the 25(OH) vitamin D level in severe haemophilia A patients and correlate it to their Hemophilia Joint Health Score (HJHS) and dual-energy X-ray absorptiometry (DEXA). We also compared the 25(OH) vitamin D and DEXA in haemophilia A and healthy children and in haemophilia A children on prophylaxis versus on-demand therapy. METHODS Fifty severe haemophilia A patients were compared to 50 age-matched healthy boys. Patients were recruited from the Pediatric Hematology Clinic, Ain Shams University from May 2017 to April 2018. Full medical history was taken with emphasis on frequency of bleeding episodes, duration and amplitude of pain assessed by the pain score. Weight, height, body mass index and HJHS were assessed. 25(OH) vit-D3, calcium, phosphorus and alkaline phosphatase were measured. BMD was assessed using Lunar DEXA, paediatric software. RESULTS People with haemophilia had significantly lower 25(OH) vit-D3 (P < .001) and DEXA z-score (P < .001) than controls. Seventy per cent of patients were on factor VIII prophylaxis twice weekly (15U/kg/dose). Significant difference was found regarding DEXA z-score (P = .012), 25(OH) vit-D3 (P = .033) and HJHS (P = .022) among patients on prophylaxis and on-demand therapy. CONCLUSION Severe haemophilia A patients showed significantly lower 25(OH) vit-D3 and DEXA than controls. Hence, vitamin D deficiency should be tested in all people with haemophilia for early diagnosis and treatment. Low-dose prophylaxis in severe haemophilia preserves BMD and increases vitamin D. Further studies are required to evaluate the effect of different prophylaxis protocols on BMD and haemophilic arthropathy.
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18
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Ekinci O, Demircioglu S, Dogan A, Merter M, Yildiz S, Demir C. Decreased bone mineral density and associated factors in severe haemophilia A patients: A case‐control study. Haemophilia 2019; 25:e315-e321. [DOI: 10.1111/hae.13836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Omer Ekinci
- Department of Hematology, Faculty of Medicine Firat University Elazig Turkey
| | - Sinan Demircioglu
- Department of Hematology, Faculty of Medicine Yuzuncu Yil University Van Turkey
| | - Ali Dogan
- Department of Hematology, Faculty of Medicine Yuzuncu Yil University Van Turkey
| | - Mustafa Merter
- Department of Hematology, Faculty of Medicine Firat University Elazig Turkey
| | - Saliha Yildiz
- Department of Endocrinology, Faculty of Medicine Yuzuncu Yil University Van Turkey
| | - Cengiz Demir
- Department of Hematology, Faculty of Medicine Yuzuncu Yil University Van Turkey
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19
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Tuan SH, Hu LY, Sun SF, Huang WY, Chen GB, Li MH, Liou IH. Risk of osteoporotic fractures as a consequence of haemophilia: A nationwide population-based cohort study. Haemophilia 2019; 25:876-884. [PMID: 31282066 DOI: 10.1111/hae.13814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023]
Abstract
AIM Low bone mineral density occurs more commonly in patients with haemophilia (PWH) than the general population. However, the risk of haemophilia-related osteoporotic fractures has not been well established. We aim to explore the relationship between haemophilia and the development of osteoporotic fractures following haemophilia. METHODS This was a nationwide population-based cohort study based on the data in the Taiwan National Health Insurance Research Database (TNHIRD). Patients who were diagnosed with haemophilia were selected. A comparison cohort was formed of patients without haemophilia who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of new-onset osteoporotic fractures were calculated for both cohorts. RESULTS The haemophilia cohort consisted of 75 patients, and the comparison cohort comprised 300 matched control patients without haemophilia. The risk of osteoporotic fractures was higher in the haemophilia cohort than in the comparison cohort (HR = 5.41, 95% confidence interval [CI] = 2.42-12.1, P < 0.001). After adjustments for age, sex, comorbidities, urbanizations and socio-economic status, PWH were 4.37 times more likely to develop osteoporotic fractures (95% CI = 1.88-10.17, P = 0.001) as compared to matched cohort. In addition, the incidence of newly diagnosed osteoporotic fractures was significantly increased after 5-year follow-up durations. CONCLUSION Though our study by TNHIRD presented methodologic flaws by its design nature, we observed that haemophilia may increase the risk of osteoporotic fractures and the cumulative incidence was significantly higher for PWH diagnosed more than 5 years. Clinicians should pay particular attention to osteoporotic fractures following haemophilia in PWH as they age.
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Affiliation(s)
- Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Fen Sun
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I-Hsiu Liou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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20
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Brunetti G, D'Amato G, Chiarito M, Tullo A, Colaianni G, Colucci S, Grano M, Faienza MF. An update on the role of RANKL-RANK/osteoprotegerin and WNT-ß-catenin signaling pathways in pediatric diseases. World J Pediatr 2019; 15:4-11. [PMID: 30343446 DOI: 10.1007/s12519-018-0198-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bone remodeling is a lifelong process due to the balanced activity of osteoclasts (OCs), the bone-reabsorbing cells, and osteoblasts (OBs), and the bone-forming cells. This equilibrium is regulated by numerous cytokines, but it has been largely demonstrated that the RANK/RANKL/osteoprotegerin and Wnt/β-catenin pathways play a key role in the control of osteoclastogenesis and osteoblastogenesis, respectively. The pro-osteoblastogenic activity of the Wnt/β-catenin can be inhibited by sclerostin and Dickkopf-1 (DKK-1). RANKL, sclerostin and DKKs-1 are often up-regulated in bone diseases, and they are the target of new monoclonal antibodies. DATA SOURCES The authors performed a systematic literature search in PubMed and EMBASE to June 2018, reviewed and selected articles, based on pre-determined selection criteria. RESULTS We re-evaluated the role of RANKL, osteoprotegerin, sclerostin and DKK-1 in altered bone remodeling associated with some inherited and acquired pediatric diseases, such as type 1 diabetes mellitus (T1DM), alkaptonuria (AKU), hemophilia A, osteogenesis imperfecta (OI), 21-hydroxylase deficiency (21OH-D) and Prader-Willi syndrome (PWS). To do so, we considered recent clinical studies done on pediatric patients in which the roles of RANKL-RANK/osteoprotegerin and WNT-ß-catenin signaling pathways have been investigated, and for which innovative therapies for the treatment of osteopenia/osteoporosis are being developed. CONCLUSIONS The case studies taken into account for this review demonstrated that quite frequently both bone reabsorbing and bone deposition are impaired in pediatric diseases. Furthermore, for some of them, bone damage began in childhood but only manifested with age. The use of denosumab could represent a valid alternative therapeutic approach to improve bone health in children, although further studies need to be carried out.
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Affiliation(s)
- Giacomina Brunetti
- Section of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | | | - Mariangela Chiarito
- Pediatric Section, Department of Biomedical Sciences and Human Oncology, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Apollonia Tullo
- Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies-IBIOM, CNR, 70126, Bari, Italy
| | - Graziana Colaianni
- Department of Emergency and Organ Transplantation, University "A. Moro" of Bari, Bari, Italy
| | - Silvia Colucci
- Section of Human Anatomy and Histology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Maria Grano
- Department of Emergency and Organ Transplantation, University "A. Moro" of Bari, Bari, Italy
| | - Maria Felicia Faienza
- Pediatric Section, Department of Biomedical Sciences and Human Oncology, University "A. Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.
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21
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Ulivieri FM, Rebagliati GAA, Piodi LP, Solimeno LP, Pasta G, Boccalandro E, Fasulo MR, Mancuso ME, Santagostino E. Usefulness of bone microarchitectural and geometric DXA-derived parameters in haemophilic patients. Haemophilia 2018; 24:980-987. [DOI: 10.1111/hae.13611] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/01/2018] [Accepted: 08/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Fabio Massimo Ulivieri
- Nuclear Medicine, Bone Metabolic Unit; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milano Italy
| | | | - Luca Petruccio Piodi
- Former: Gastroenterology and Endoscopy Unit; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milano Italy
| | - Luigi Piero Solimeno
- Ortopedic and Traumatology Unit; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milano Italy
| | - Gianluigi Pasta
- Orthopedics and Traumatology Clinic; IRCCS Fondazione San Matteo; Pavia Italy
| | - Elena Boccalandro
- Ortopedic and Traumatology Unit; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milano Italy
| | - Maria Rosaria Fasulo
- Former: Angelo Bianchi Bonomi Haemophilia and Thrombosis Center; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milano Italy
| | - Maria Elisa Mancuso
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milano Italy
| | - Elena Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milano Italy
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22
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Xafaki P, Balanika A, Pergantou H, Papakonstantinou O, Platokouki H. Impact of target joint and FVIII inhibitor οn bone properties in children with haemophilia A: A peripheral quantitative computed tomography study. Haemophilia 2018; 24:800-806. [PMID: 30088693 DOI: 10.1111/hae.13591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/22/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Haemophilic children are prone to low bone mass accrual. OBJECTIVE To assess bone properties in haemophilic children, using peripheral quantitative computed tomography (pQCT) and to correlate findings with clinical data. SUBJECTS/METHODS Peripheral quantitative computed tomography scan of both radii and tibiae were performed in 31 haemophilic A children (severe 24, mean age 11.2 years). Seven subjects had a history of inhibitors. Five children had an upper extremity target-joint and 12 had at least one lower extremity target-joint. The following parameters were measured: trabecular, total and cortical bone density and content (TBD, ToBD, CBD, TbC, CC), strength-stress index (SSI), and tibial cross-sectional area (CA), outer and inner bone contour length (PERI, ENDO) and cortical thickness (CTHC). RESULTS Mean right radius TBD was significantly higher than the left one (P = 0.015). In subjects with arm target-joint, radius TBD was significantly lower in the target than in non-target arm (186.6 ± 60.4 vs 218.6 ± 39.8, P = 0.032). Left arm target-joint subjects had significantly lower left radius TBD in comparison to subjects without arm target-joint (155.4 ± 50.3 vs 215.7 ± 37.9, P = 0.019). There were no similar differences in leg target-joint. Bone quality and geometry parameters in cortical compartment were significantly lesser in inhibitor group, with statistically significant side-to-side differences for legs and arms and left side predominance. CONCLUSION In children with haemophilia A and a history of target-joint and/or FVIII inhibitor, abnormalities may occur in the long bones as were revealed by pQCT, where low trabecular density and weak cortical bone quality in upper and lower extremities, respectively, were confirmed.
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Affiliation(s)
- Panagiota Xafaki
- Haemophilia Centre- Haemostasis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Alexia Balanika
- Second Radiology Department, "Attikon" University Hospital, Athens, Greece
| | - Helen Pergantou
- Haemophilia Centre- Haemostasis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - Helen Platokouki
- Haemophilia Centre- Haemostasis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
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23
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Sossa Melo CL, Wandurraga EA, Peña AM, Jiménez SI, Salazar LA, Ochoa ME, Luna-Gonzalez ML, Ortiz ML, Morales K, Ayala-Castillo M, Reyes DL, Chalela CM. Low bone mineral density and associated factors in patients with haemophilia in Colombia. Haemophilia 2018; 24:e222-e229. [DOI: 10.1111/hae.13516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 01/15/2023]
Affiliation(s)
- C. L. Sossa Melo
- Division of Hematology and Hematopoietic Stem Cell Transplantation; Department of Internal Medicine; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
- Hematology and Hematopoietic Stem Cell Transplantation Unit; Clinica Carlos Ardila Lulle; Bucaramanga Colombia
| | - E. A. Wandurraga
- Department of Endocrinology; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
| | - A. M. Peña
- Division of Hematology and Hematopoietic Stem Cell Transplantation; Department of Internal Medicine; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
- Hematology and Hematopoietic Stem Cell Transplantation Unit; Clinica Carlos Ardila Lulle; Bucaramanga Colombia
| | - S. I. Jiménez
- Division of Hematology and Hematopoietic Stem Cell Transplantation; Department of Internal Medicine; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
- Hematology and Hematopoietic Stem Cell Transplantation Unit; Clinica Carlos Ardila Lulle; Bucaramanga Colombia
| | - L. A. Salazar
- Division of Hematology and Hematopoietic Stem Cell Transplantation; Department of Internal Medicine; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
- Hematology and Hematopoietic Stem Cell Transplantation Unit; Clinica Carlos Ardila Lulle; Bucaramanga Colombia
| | - M. E. Ochoa
- Department of Public Health; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
| | - M. L. Luna-Gonzalez
- Research Department; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
| | - M. L. Ortiz
- Hematology and Hematopoietic Stem Cell Transplantation Unit; Clinica Carlos Ardila Lulle; Bucaramanga Colombia
| | - K. Morales
- Division of Hematology; Department of Internal Medicine; School of Medicine; Universidad Nacional Autonoma de Mexico; Ciudad de Mexico Mexico
| | - M. Ayala-Castillo
- Division of Hematology and Hematopoietic Stem Cell Transplantation; Department of Internal Medicine; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
| | - D. L. Reyes
- Division of Hematology and Hematopoietic Stem Cell Transplantation; Department of Internal Medicine; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
| | - C. M. Chalela
- Division of Hematology and Hematopoietic Stem Cell Transplantation; Department of Internal Medicine; School of Medicine; Universidad Autonoma de Bucaramanga; Bucaramanga Colombia
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Dagli M, Kutlucan A, Abusoglu S, Basturk A, Sozen M, Kutlucan L, Unlu A, Yilmaz F. Evaluation of bone mineral density (BMD) and indicators of bone turnover in patients with hemophilia. Bosn J Basic Med Sci 2018; 18:206-210. [PMID: 29236646 DOI: 10.17305/bjbms.2018.2335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022] Open
Abstract
A decrease in bone mass is observed in hemophilic patients. The aim of this study was to evaluate bone mineral density (BMD), parathyroid hormone (PTH), 25-hydroxy vitamin D (vitamin D), and a bone formation and resorption marker, procollagen type I N-terminal propeptide (PINP) and urinary N-terminal telopeptide (uNTX) respectively, in hemophilic patients and healthy controls. Laboratory parameters related to the pathogenesis of bone loss such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were also evaluated. Thirty-five men over 18 years of age, with severe hemophilia (A and B) and receiving secondary prophylaxis, were included in the study. The same number of age-, sex-, and ethnicity-matched healthy controls were evaluated. Anthropometric, biochemical, and hormonal parameters were determined in both groups. No significant difference in anthropometric parameters was found between the two groups. The BMD was low in 34% of hemophilic patients. Vitamin D, calcium, and free testosterone levels were significantly lower (p < 0.001, p = 0.011, p < 0.001, respectively), while PTH, PINP, and activated partial thromboplastin time (aPTT) levels were significantly higher (p < 0.014, p = 0.043, p < 0.001, respectively), in hemophilic patients compared to controls. There was no significant difference between the two groups in NLR, PLR, phosphorus, thyroid-stimulating hormone, and uNTX level. The reduction of bone mass in hemophilic patients may be evaluated using the markers of bone formation and resorption, enabling early detection and timely treatment.
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Affiliation(s)
- Mehmet Dagli
- Department of Internal Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey.
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25
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Vyzantiadis TA, Charizopoulou M, Adamidou F, Karras S, Goulis D, Karagiannis A, Garipidou V, Vakalopoulou S, Anagnostis P. The effect of monthly ibandronate on bone mineral density and bone turnover markers in patients with haemophilia A and B and increased risk for fracture. Thromb Haemost 2017; 110:257-63. [DOI: 10.1160/th13-01-0030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/30/2013] [Indexed: 12/23/2022]
Abstract
SummaryHaemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, no study has so far evaluated the effects of anti-osteoporotic therapy on BMD in haemophilia. The primary endpoint of this prospective study was to estimate the effect of 12-month therapy of oral ibandronate 150 mg/ month on BMD in patients with haemophilia A and B. Secondary endpoint was its effect on turnover markers (BTM) of bone resorption [serum C-terminal telopeptide of type 1 collagen (sCTX), tartrate-resistant acid phosphatase band 5b] and bone formation (osteocalcin and bone-specific alkaline phosphatase. Ten adult patients with T-score < −2.5 SD or Z-score < −2 and/or increased risk of fracture according to FRAX model were included. All received 1,000 mg/day calcium carbonate with 800 IU/d cholecalciferol. Males with haemophilia A (n=7) or B (n=3) (mean age 43.5 ± 13.5 years) were studied. Ibandronate resulted in an increase in lumbar BMD (from 0.886 ± 0.169 to 0.927 ± 0.176 g/cm2, 4.7%, p=0.004). No change in BMD of total hip (from 0.717 ± 0.128 to 0.729 ± 0.153 g/cm2, p=0.963) or femoral neck (0.741 ± 0.135 to 0.761 ± 0.146 g/cm2, p=0.952) was noticed. Ibandronate led to a decrease in sCTX (from 0.520 ± 0.243 to 0.347 ± 0.230 ng/ml, −29.9%, p=0.042). No change was observed in other BTM. Ibandronate was generally well-tolerated. In conclusion, ibandronate significantly improved BMD in lumbar spine and reduced bone resorption in adults with haemophilia at increased risk of fracture. Its effect on hip BMD and bone formation markers was not significant.
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Anagnostis P, Vakalopoulou S, Christoulas D, Paschou SA, Papatheodorou A, Garipidou V, Kokkoris P, Terpos E. The role of sclerostin/dickkopf-1 and receptor activator of nuclear factor kB ligand/osteoprotegerin signalling pathways in the development of osteoporosis in patients with haemophilia A and B: A cross-sectional study. Haemophilia 2017; 24:316-322. [PMID: 29194852 DOI: 10.1111/hae.13384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/19/2022]
Abstract
AIM Haemophilia A and B are associated with reduced bone mineral density (BMD). The aim of this study was to assess circulating sclerostin and dickkopf-1 (Dkk-1), (inhibitors of osteoblastic differentiation), as well as the receptor activator of nuclear factor kB ligand (RANKL)/osteoprotegerin (OPG) system (the major regulator of osteoclastogenesis), in patients with haemophilia (PWH), their possible correlations with clinical risk factors and the effect of ibandronate on these markers. METHODS Eighty-nine male PWH (mean age 45.9 ± 15.3 years) and 30 age-matched healthy male controls participated. BMD was assessed by DXA. Sclerostin, Dkk-1, RANKL and OPG were measured in serum of patients, controls, as well as in ten patients receiving oral ibandronate (150 mg/mo), at baseline and after 12 months. RESULTS Patients with haemophilia had lower circulating sclerostin (median ± IQR: 47.4 ± 26.93 vs 250 ± 250 pmol/L, P < .001), Dkk-1 (21.24 ± 17.18 vs 26.16 ± 15.32pg/mL, P = .04) and higher levels of RANKL (0.23 ± 0.03 vs 0.04 ± 0.03 pmol/L, P = .001), RANKL/OPG ratio (0.063 ± 0.25 vs 0.005 ± 0.11, P = .001) compared with controls. Patients with low BMD had higher OPG concentrations compared to those with normal BMD. Sclerostin and RANKL/OPG correlated positively with BMD. Patients with severe haemophilia had lower sclerostin concentrations compared with those with mild or moderate disease. The degree of arthropathy negatively correlated with sclerostin and Dkk-1 levels. PWH who received ibandronate showed a decrease in serum Dkk-1 without any significant effect on sclerostin and RANKL/OPG. CONCLUSIONS Patients with haemophilia present increased osteoclastic activity coupled with compensatory increased osteoblastic activity. Ibandronate did not affect RANKL/OPG ratio, but it decreased Dkk-1.
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Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Vakalopoulou
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Christoulas
- Department of Haematology, 251 General Air Force Hospital, Athens, Greece
| | - S A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Papatheodorou
- Department of Haematology, 251 General Air Force Hospital, Athens, Greece
| | - V Garipidou
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Kokkoris
- Department of Endocrinology, 251 General Air Force Hospital, Athens, Greece
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Pathophysiology of Hemophilic Arthropathy. J Clin Med 2017; 6:jcm6070063. [PMID: 28672826 PMCID: PMC5532571 DOI: 10.3390/jcm6070063] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023] Open
Abstract
Spontaneous joint bleeding and repeated hemarthroses lead to hemophilic arthropathy—a debilitating disease with a significant negative impact on mobility and quality of life. Iron, cytokines, and angiogenic growth factors play a pivotal role in the onset of the inflammatory process that involves the synovial tissue, articular cartilage, and subchondral bone, with early damages and molecular changes determining the perpetuation of a chronic inflammatory condition. Synovitis is one of the earliest complications of hemarthrosis, and is characterized by synovial hypertrophy, migration of inflammatory cells, and a high degree of neo-angiogenesis with subsequent bleeding. The pathogenic mechanisms and molecular pathways by which blood in the joint cavity causes articular cartilage and subchondral bone destruction have yet to be fully elucidated. Both cytokines and matrix metalloproteinases and hydroxyl radicals may induce chondrocyte apoptosis. Members of the tumor necrosis factor receptor superfamily (such as the molecular triad: osteoprotegerin—OPG; receptor activator of nuclear factor κB—RANK; RANK ligand—RANKL) seem instead to play a major role in the inflammatory process. These pathogenic processes interact with each other and ultimately lead to a fibrotic joint and the disabling condition characteristic of hemophilic arthropathy.
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Hua B, Olsen EHN, Sun S, Gudme CN, Wang L, Vandahl B, Roepstorff K, Kjelgaard-Hansen M, Sørensen BB, Zhao Y, Karsdal MA, Manon-Jensen T. Serological biomarkers detect active joint destruction and inflammation in patients with haemophilic arthropathy. Haemophilia 2017; 23:e294-e300. [PMID: 28439941 DOI: 10.1111/hae.13196] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Progressive arthropathy caused by recurrent joint bleeds is a severe complication in haemophilia. AIM We investigated whether biomarkers of cartilage and bone degradation, and inflammation were altered in haemophilia patients and whether these biomarkers could identify haemophilia patients with arthropathy. METHODS Serum from 35 haemophilia patients with varying degrees of arthropathy and 43 age- and gender-matched control subjects were analysed. Biomarkers of cartilage degradation (C2M, COMP, CTX-II, ADAMTS5), cartilage formation (PRO-C2), bone formation (PINP), bone resorption (CTX-I) and inflammation (hsCRP, CRPM) were measured by ELISA. Arthropathy was assessed by radiological evaluation (Pettersson score) and physical examination (Gilbert score). RESULTS In patients with haemophilia, cartilage degradation, measured by C2M, CTX-II and COMP, was increased by 25% (P < 0.05) compared with control subjects. Levels of the cartilage degradation enzyme, ADAMTS5, were 10% lower in haemophilia patients (P < 0.05). Bone formation (PINP) was reduced by 25% (P < 0.05) in haemophilia patients, whereas bone resorption (CTX-I) was increased by 30% (P < 0.001). Acute inflammation (hsCRP) was increased by 50% (P < 0.01), whereas chronic inflammation (CRPM) was decreased by 25% (P < 0.0001). The hsCRP/CRPM ratio was 60% higher (P < 0.001) in haemophilia patients relative to control subjects. A biomarker panel combining C2M, CRPM, and ADAMTS5 could distinguish haemophilia patients from control subjects with 85.3% accuracy (P < 0.0001). We found no strong correlation between biomarkers and radiological and physical examination of the joint. CONCLUSION Biomarkers detect increased cartilage and bone degradation, and altered inflammatory activity in haemophilia patients with arthropathy. These biomarkers could potentially be used to identify patients with progressing joint disease.
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Affiliation(s)
- B Hua
- Department of Hematology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Peking Union Medical College Hospital (PUMCH), Beijing, China
| | - E H N Olsen
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - S Sun
- Nordic Bioscience A/S, Herlev, Denmark
| | - C N Gudme
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - L Wang
- Novo Nordisk Research Centre China, Beijing, China
| | - B Vandahl
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - K Roepstorff
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | | | - B B Sørensen
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - Y Zhao
- Department of Hematology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Peking Union Medical College Hospital (PUMCH), Beijing, China
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Vitamin D deficiency and osteoporosis in hemophilic children: an intermingled comorbidity. Blood Coagul Fibrinolysis 2017; 28:14-18. [PMID: 26825623 DOI: 10.1097/mbc.0000000000000519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate bone state and factors affecting it in children with hemophilia. This is a case-control study that included 37 children with hemophilia and 37 healthy controls. The patients were selected from the outpatient pediatric hematology clinic of Fayoum University Hospital, Egypt. Bone mineral density, serum vitamin D, parathormone, calcium, phosphorus, and calcium creatinine ratio levels were evaluated. Vitamin D level and bone mineral density were significantly lower in hemophiliacs than in control group (P < 0.0001). About 43.2% of cases had moderate vitamin D deficiency, whereas 35.1% had mild deficiency. Vitamin D positively correlated with bone mineral density Z-score, whereas it negatively correlated with total joint score. Positive correlation between bone mineral density and age was also found. Serum levels of urea, urinary calcium creatinine ratio, and parathormone were found to be higher in cases than in control. Also, serum calcium level was found to be lower in patients than in controls. We concluded that vitamin D deficiency is an essential cause of decreased bone mineral density in hemophilic children. Hemophilic arthropathy with consecutive immobilization plays an important role in vitamin D deficiency and decreased bone mineral density.
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Pathophysiology of hemophilic arthropathy and potential targets for therapy. Pharmacol Res 2017; 115:192-199. [DOI: 10.1016/j.phrs.2016.11.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 01/14/2023]
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Haemophilia A and B as a cause for secondary osteoporosis and increased fracture risk. Blood Coagul Fibrinolysis 2016; 26:599-603. [PMID: 26126168 DOI: 10.1097/mbc.0000000000000330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the increasing evidence regarding its association with low bone mineral density (BMD) both in adults and children, haemophilia A or B has not yet been considered among the classic causes of secondary osteoporosis. Although the exact mechanisms are not fully elucidated, physical inactivity and vitamin D deficiency seem to play a fundamental role for such an association. Viral infections and arthropathy further compromise bone mass. Except for low BMD, patients with haemophilia seem to be at increased risk for fracture and falls. The FRAX tool may be of value in this population, for the estimation of fracture risk. Regular exercise, prophylactic factor replacement therapy in severe haemophilia, fall prevention strategies and optimization of calcium and vitamin D intake are recommended. In any case, individualized multidisciplinary approach and careful assessment and management of fracture risk are recommended.
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Xiao H, Xue Y, Gu S, Wang J, Sun H, Lu H. Efficacy and safety of antiretroviral regimens including raltegravir to treat HIV-infected patients with hemophilia. Biosci Trends 2016; 10:42-6. [PMID: 26911541 DOI: 10.5582/bst.2015.01180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When treating HIV-infected patients with hemophilia, adverse drug reactions and interactions and the effect of treatment on bleeding disorders must be considered. Raltegravir is the first HIV integrase inhibitor, but its use in patients with hemophilia is rarely reported. Nine HIV-positive patients with hemophilia were retrospectively studied with a focus on the virological response, changes in the CD4 count, the tendency to bleed, and the response to replacement therapy before and after raltegravir-based antiretroviral therapy (ART). The nine patients were highly treatment-experienced patients and they received raltegravir-based ART for at least nine months. The patients had their own reasons for changing to raltegravir-based ART. During treatment, the CD4 count increased progressively in four patients, with a median absolute increase of 233 cells/mm(3), while the count stabilized in the remaining five patients. Two previous recipients of lopinavir/ritonavir (LPV/r) who failed to respond to lamivudine (3TC) + zidovudine (ZDV) + efavirenz (EFV) had a viral rebound. Genotyping indicated multidrug resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). A pattern of resistance to raltegravir was evident, including the primary mutation N155H and the secondary mutation T97A. In the two patients, the tendency to bleed decreased markedly and monthly usage of clotting factor VIII decreased significantly decreased. In the remaining seven patients, the viral load remained < 40 copies/mL, there was no evidence of an increased tendency to bleed, and no evidence of changes in the response to replacement therapy. All of the patients had a stable condition with no signs of disease progression and no serious adverse reactions. Results indicated that Raltegravir-based therapy offered a safe and well-tolerated option for HIV-positive patients with hemophilia.
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Affiliation(s)
- Hong Xiao
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
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Anagnostis P, Karras SN, Vakalopoulou S, Terpos E. Haemophilia and low bone mass. Ok, but what about fracture risk? Haemophilia 2016; 22:11-4. [DOI: 10.1111/hae.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/05/2015] [Indexed: 12/18/2022]
Affiliation(s)
- P. Anagnostis
- Second Propedeutic Department of Internal Medicine; Haemophilia Centre of Northern Greece; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
- Unit of Reproductive Endocrinology; First Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - S. N. Karras
- Unit of Reproductive Endocrinology; First Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - S. Vakalopoulou
- Second Propedeutic Department of Internal Medicine; Haemophilia Centre of Northern Greece; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - E. Terpos
- Department of Clinical Therapeutics; School of Medicine; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
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Zhang S, Lu C, Ying J, Wang P, Xu T, Chen D, Jin H, Tong P. Inflammatory focal bone destruction in femoral heads with end-stage haemophilic arthropathy: a study on clinic samples with micro-CT and histological analyses. Haemophilia 2015; 21:e472-8. [PMID: 26388304 DOI: 10.1111/hae.12808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Focal bone destruction has a high prevalence in haemophilic arthropathy (HA) affected joints, but the mechanism remains unclear. AIM We undertook this study on clinic samples to explore the focal bone destruction in femoral heads suffered with end-stage HA. METHODS Twenty-one femoral heads from HA patients and 19 femoral heads from rheumatoid arthritis (RA) patients were scanned by micro-CT. Histological analysis, including TRAP staining of subchondral bone were performed to evaluate the bone destruction and osteoclasts activity. RANKL, OPG as well as pro-inflammatory cytokines, such as TNF-α and IL-1β in subchondral bone were detected by immunohistochemistry (IHC) method. RESULTS Severe focal lesion was observed in all the HA and RA femoral heads by micro-CT imaging and histological analysis. The mean percentage of lesion volume to total volume of the femoral heads from HA patients was significantly higher than those from RA patients. There was no significant difference in osteoclasts numbers in subchondral bone between HA and RA groups. By IHC analysis, high expression of RANKL, TNF-α, IL-1β and low expression of OPG and RANK were observed in subchondral bone, and there were no significant differences in the expression of RANKL, OPG, RANK, TNF-α and IL-1β in femoral heads derived from HA and RA patients. CONCLUSION Our findings demonstrated the focal bone destruction coupled with inflammatory osteoclastogenesis at subchondral bone in femoral heads from patients with end-stage HA, and that was similar to the changes in the femoral heads of RA patients.
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Affiliation(s)
- S Zhang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Institute of Orthopaedics and Traumatology of Zhejiang Province, Hangzhou, Zhejiang, China.,Department of Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | - C Lu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - J Ying
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - P Wang
- Institute of Orthopaedics and Traumatology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - T Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - D Chen
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | - H Jin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Institute of Orthopaedics and Traumatology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - P Tong
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Institute of Orthopaedics and Traumatology of Zhejiang Province, Hangzhou, Zhejiang, China.,Department of Orthopaedics Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Wang KC, Amirabadi A, Wang KC, Moineddin R, Jong R, Tomlinson C, Doria AS. Longitudinal assessment of bone loss using quantitative ultrasound in a blood-induced arthritis rabbit model. Haemophilia 2015; 21:e402-10. [PMID: 26178807 DOI: 10.1111/hae.12743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Osteoporosis is common in haemophilic arthropathy. Quantitative ultrasound (QUS) can be a suitable alternative for dual-energy x-ray absorptiometry for diagnosing osteoporosis in haemophiliacs due to its lack of ionizing radiation, and ease to use. AIM We investigated the intra- and inter-operator reliability of QUS, its responsiveness to bone growth, its ability to differentiate bone adjacent to blood-injected vs. control joints, and the effect of soft tissues on the speed of sound (SOS) QUS values in a juvenile white New Zealand rabbit model of blood-induced arthritis. METHODS Eight of 16 rabbits were injected with autologous blood (0.1 mL kg(-1) ) 8 times over a 17-week period, the remaining eight rabbits served as controls. SOS was measured at baseline, weeks 8 and 17 in vivo and after the bones were excised on week 17. RESULTS Intra- and inter-operator coefficients of variation for QUS data were <5% and intraclass correlation coefficients were >60% for 22/27 (81.5%) of bones assessed. The level of interval increase in SOS values from baseline to week 17 was significantly different in tibiae of injected, contralateral to injected and non-injected knee groups by anova (P = 0.01). In vivo (mean ± SD, 4147.17 ± 96.27 m s(-1) ) and postmortem (4457.85 ± 104.00 m s(-1) ) measurements on week 17 differed (P < 0.01) indicating an effect of soft tissues on SOS. CONCLUSION In conclusion, QUS' acceptable reliability, its responsiveness to growth-related changes and its ability to discriminate injected and non-injected joints make this technique a plausible candidate as a diagnostic tool for osteoporosis in the paediatric haemophilic population if these results are confirmed upon animal-human translation.
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Affiliation(s)
- K C Wang
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - A Amirabadi
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - K C Wang
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - R Jong
- Department of Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - C Tomlinson
- Department of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - A S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
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Kempton CL, Antoniucci DM, Rodriguez-Merchan EC. Bone health in persons with haemophilia. Haemophilia 2015; 21:568-77. [DOI: 10.1111/hae.12736] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 12/20/2022]
Affiliation(s)
- C. L. Kempton
- Department of Pediatrics and Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - D. M. Antoniucci
- Division of Endocrinology Sutter Pacific Medical Foundation; Department of Medicine University of California; San Francisco CA USA
| | - E. C. Rodriguez-Merchan
- Department of Orthopaedic Surgery; La Paz University Hospital; Madrid Spain
- School of Medicine; Autonomous University; Madrid Spain
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Wells AJ, McLaughlin P, Simmonds JV, Prouse PJ, Prelevic G, Gill S, Chowdary P. A case-control study assessing bone mineral density in severe haemophilia A in the UK. Haemophilia 2014; 21:109-15. [PMID: 25382849 DOI: 10.1111/hae.12565] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 11/27/2022]
Abstract
It has been shown that bone mineral density (BMD) may be lower in patients with haemophilia (PWH). A comparison to control subjects is required to thoroughly assess current BMD in PWH in the UK. The objective of this study was to test the hypothesis that BMD is lower in PWH than in controls, and in patients with more severely affected joints or lower activity levels. In this case-control study, 37 patients with severe haemophilia A were recruited from two haemophilia centres in the UK. A group of 37 age, gender and ethnicity-matched control participants were recruited. All participants had a bone density scan, a musculoskeletal assessment, a blood test for vitamin D and completed a functional activity questionnaire. Of the case group, 5% had osteoporosis and 24% had BMD lower than expected for age. No control participants had osteoporosis, 3% had osteopenia and 14% had BMD lower than expected for age. Ninety one per cent of case participants and 92% of control participants had reduced 25(OH)D levels. Case participants had significantly lower BMD than control participants, and case participants with more severely affected joints, lower activity levels, HIV, history of hepatitis C or lower BMI had significantly lower BMD. Patients with severe haemophilia have a higher risk of low BMD than men without haemophilia. Patients with more severely affected joints and lower activity levels have lower BMD. It remains unclear whether patients with low BMD reached adequate peak bone mass. Low vitamin D may be present in the majority of PWH.
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Affiliation(s)
- A J Wells
- Haemophilia, Haemostasis & Thrombosis Centre, Basingstoke & North Hampshire Hospital, Basingstoke, UK; University of Hertfordshire, Hatfield, UK
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Anagnostis P, Karras SN, Goulis DG. Bone disease in patients with haemophilia A and B - where are we now? Haemophilia 2014; 21:1-3. [DOI: 10.1111/hae.12551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 11/27/2022]
Affiliation(s)
- P. Anagnostis
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
- Unit of Reproductive Endocrinology; First Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - S. N. Karras
- Unit of Reproductive Endocrinology; First Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - D. G. Goulis
- Unit of Reproductive Endocrinology; First Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
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Parhampour B, Torkaman G, Hoorfar H, Hedayati M, Ravanbod R. Effects of short-term resistance training and pulsed electromagnetic fields on bone metabolism and joint function in severe haemophilia A patients with osteoporosis: a randomized controlled trial. Clin Rehabil 2013; 28:440-50. [PMID: 24249841 DOI: 10.1177/0269215513505299] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the effects of short-term resistance training and pulsed electromagnetic fields on bone metabolism and joint function in patients with haemophilia with osteoporosis. DESIGN A randomized, controlled, patient and blood sample assessor-blinded, six-week trial, three times weekly. SETTING Hospital outpatients with severe haemophilia A and osteoporosis. SUBJECTS Forty-eight patients were randomly assigned to resistance training (RT, n = 13), combined resistance training with pulsed electromagnetic fields (RTPEMF, n = 12), pulsed electromagnetic fields (PEMF, n = 11) and control (n = 12) groups. INTERVENTION The RT group received 30-40 minutes of resistance exercises and placebo pulsed electromagnetic fields. The RTPEMF group received the same exercises with lower repetition and 30 minutes of pulsed electromagnetic fields. The PEMF group was exposed to 60 minutes of pulsed electromagnetic fields (30 Hz and 40 Gauss). MAIN MEASURES Bone-specific alkaline phosphatase, N-terminal telopeptide of type 1 collagen, and joint function, using the modified Colorado Questionnaire, were measured before and after the programme. RESULTS The absolute change of bone-specific alkaline phosphatase was significant in the RT and RTPEMF groups compared with the control group (25.41 ± 14.40, 15.09 ± 5.51, and -4.73 ± 2.93 U/L, respectively). The absolute changes in the total score for joint function were significant for knees, ankles, and elbows in the RT group (9.2 ± 1.38, 5.1 ± 0.5, and 3.2 ± 0.8, respectively) and the RTPEMF group (7.7 ± 1.0, 3.3 ± 0.6, and 2.5 ± 0.7, respectively) compared to the PEMF and control groups. This value was significant for knee joints in the PEMF group compared to the control group (3.4 ± 0.5 and 0.66 ± 0.4, respectively). CONCLUSIONS Resistance training is effective for improving bone formation and joint function in severe haemophilia A patients with osteoporosis.
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Anagnostis P, Vakalopoulou S, Karras S, Charizopoulou M, Garipidou V. The role of arthropathy in the development of osteoporosis in patients with haemophilia: do we need more? Haemophilia 2013; 20:e83-5. [PMID: 24165289 DOI: 10.1111/hae.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Anagnostis P, Vakalopoulou S, Vyzantiadis TA, Charizopoulou M, Karras S, Goulis DG, Karagiannis A, Gerou S, Garipidou V. The clinical utility of bone turnover markers in the evaluation of bone disease in patients with haemophilia A and B. Haemophilia 2013; 20:268-75. [PMID: 24118364 DOI: 10.1111/hae.12271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 01/01/2023]
Abstract
Haemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, the utility of bone turnover markers (BTM) remains unknown. The aim of this study was to evaluate bone metabolism in men with haemophilia and to investigate associations between BTM and bone disease. Serum N- (NTX-I), C-terminal telopeptide of type I collagen (CTX-I) and tartrate-resistant acid phosphatase band-5b (TRAP-5b), as bone resorption markers, and osteocalcin (OC) and bone-specific alkaline phosphatase (b-ALP), as bone formation markers, were assessed. Seventy men with haemophilia A (n = 59) or B (n = 11) were studied. Patients with low BMD had significantly higher b-ALP concentrations compared with those with normal BMD (12.8 ± 1.60 vs. 9.72 ± 0.58 μg/L, P = 0.009), without any differences in the other BTM. NTX-I and CTX-I concentrations were negatively associated with oestradiol levels and hip BMD and positively with human immunodeficiency virus infection, number of affected joints and arthropathy scores. B-ALP and OC concentrations were negatively associated with hip BMD, severity of haemophilia and fracture history, and positively with the number of affected joints and testosterone concentrations. After multivariate analysis, NTX-I levels remained negatively associated with oestradiol levels, whereas b-ALP concentrations negatively correlated with the level of physical activity and positively with the number of affected joints. Increased bone metabolism exists in men with haemophilia and low BMD. Increased b-ALP levels may identify patients at high risk for fracture. Increased number of target joints, low physical activity and low oestradiol concentrations are independently associated with increased bone metabolism.
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Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Kempton CL, Antun A, Antoniucci DM, Carpenter W, Ribeiro M, Stein S, Slovensky L, Elon L. Bone density in haemophilia: a single institutional cross-sectional study. Haemophilia 2013; 20:121-8. [PMID: 23902277 DOI: 10.1111/hae.12240] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 11/30/2022]
Abstract
Haemophilia has been associated with low bone mineral density (BMD). However, prior clinical studies of this population have neither clearly elucidated risk factors for development of low BMD nor identified who may warrant screening for osteoporosis. The aim of the study was to evaluate the relationship between BMD and haemophilic arthropathy and other demographic and clinical variables. We undertook a cross-sectional study of BMD in adult men with haemophilia. Measures of predictor variables were collected by radiographic studies, physical examination, patient questionnaires and review of medical records. Among 88 enrolled subjects, the median age was 41 years (IQR: 20); median femoral neck BMD (n = 87) was 0.90 g cm(-2) (IQR: 0.24); and median radiographic joint score was 7.5 (IQR: 18). Among subjects <50 years (n = 62), after controlling for BMI, alcohol, HIV and White race, BMD decreased as radiographic joint score increased (est. β = -0.006 mg cm(-2) ; 95% CI -0.009, -0.003; partial R(2) = 0.23). Among subjects ≥50 years (n = 26), 38% had osteoporosis (T score less than or equal to -2.5) and there was no association between BMD and arthropathy. Risk factors for low BMD in men with haemophilia <50 years include haemophilic arthropathy, low or normal BMI and HIV. Men with haemophilia over age 50 years should have routine screening for detection of osteoporosis.
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Affiliation(s)
- C L Kempton
- Department of Haematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center, Childrens Healthcare of Atlanta, Atlanta, GA, USA
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Anagnostis P, Vakalopoulou S, Charizopoulou M, Kazantzidou E, Chrysopoulou T, Moka E, Agapidou A, Zournatzi V, Garipidou V. Is there any association between leptin levels and bone mineral density in haemophiliac men? Arch Med Sci 2013; 9:459-65. [PMID: 23847667 PMCID: PMC3701978 DOI: 10.5114/aoms.2013.35341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 07/21/2012] [Accepted: 08/01/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Conflicting data exist regarding the role of leptin in bone metabolism. The purpose of the present study was to investigate serum leptin concentrations in male patients with haemophilia A and B, a disease known to be associated with low bone mass. MATERIAL AND METHODS Eighty-one male patients, aged 45.4 ±15 years, were screened. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) in lumbar spine (LS), femoral neck (FN) and total hip (TH). RESULTS Low bone mass was diagnosed in 20 patients (24.7%). Serum leptin concentrations were strongly associated with body weight (r s = 0.457, p = 0.0001) and body mass index (BMI) (r s = 0.491, p = 0.0001). In unadjusted analysis leptin was inversely associated with BMD in LS (r s = -0.255, p = 0.023), but not in FN and TH (r s = -0.205, p = 0.068 and r s = -0.191, p = 0.090, respectively). However, after adjusting for BMI and body weight, leptin was inversely associated with BMD in FN (F 1,76 = 7.727, p = 0.007, β = -0.371, ΔR (2) = 0.089) and TH (F 1,76 = 4.533, p = 0.036, β = -0.290, ΔR (2) = 0.054), but not in LS (F 1,75 = 2.076, p = 0.154, β = -0.202, ΔR (2) = 0.026). No association was found between age, presence of HBV, HCV or HIV infection or alkaline phosphatase and leptin levels. CONCLUSIONS Our study showed a negative association between circulating leptin levels and bone mass in males, independently of body weight and BMI.
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Affiliation(s)
| | - Sofia Vakalopoulou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Maria Charizopoulou
- Department of Psychology, School of Philosophy, Aristotle University of Thessaloniki, Greece
| | | | | | - Eleni Moka
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Alexandra Agapidou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Vassiliki Zournatzi
- 2 Department of Obstetrics and Gynaecology, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
| | - Vasilia Garipidou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
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Recht M, Liel MS, Turner RT, Klein RF, Taylor JA. The bone disease associated with factor VIII deficiency in mice is secondary to increased bone resorption. Haemophilia 2013; 19:908-12. [DOI: 10.1111/hae.12195] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
- M. Recht
- The Hemophilia Center; Oregon Health & Science University; Portland OR USA
| | - M. S. Liel
- The Hemophilia Center; Oregon Health & Science University; Portland OR USA
- Portland Veterans Affairs Medical Center; Portland OR USA
| | - R. T. Turner
- Skeletal Biology, College of Public Health and Human Sciences; Oregon State University; Corvallis OR USA
| | - R. F. Klein
- Bone and Mineral Research Unit; Division of Endocrinology; Oregon Health & Science University; Portland OR USA
| | - J. A. Taylor
- The Hemophilia Center; Oregon Health & Science University; Portland OR USA
- Portland Veterans Affairs Medical Center; Portland OR USA
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Anagnostis P, Vakalopoulou S, Charizopoulou M, Karras S, Garipidou V. Vitamin D deficiency in patients with haemophilia: an underestimated commorbidity. Haemophilia 2013; 19:e308-10. [DOI: 10.1111/hae.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/28/2022]
Affiliation(s)
- P. Anagnostis
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
| | - S. Vakalopoulou
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
| | - M. Charizopoulou
- Department of Psychology; School of Philosophy; Aristotle University; Thessaloniki; Greece
| | - S. Karras
- Department of Endocrinology and Metabolism; Agios Pavlos General Hospital; Thessaloniki; Greece
| | - V. Garipidou
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
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Linari S, Montorzi G, Bartolozzi D, Borderi M, Melchiorre D, Benelli M, Morfini M. Hypovitaminosis D and osteopenia/osteoporosis in a haemophilia population: a study in HCV/HIV or HCV infected patients. Haemophilia 2012; 19:126-33. [DOI: 10.1111/j.1365-2516.2012.02899.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- S. Linari
- Agency for Haemophilia; University Hospital of Firenze; Firenze
| | - G. Montorzi
- Agency for Haemophilia; University Hospital of Firenze; Firenze
| | - D. Bartolozzi
- Infectious Diseases Unit; University Hospital of Firenze; Firenze
| | - M. Borderi
- Infectious Diseases Unit; University Hospital of Bologna; Bologna
| | - D. Melchiorre
- Department of Bio-Medicine; University Hospital of Firenze; Firenze
| | - M. Benelli
- Diagnostic Genetic Unit; University Hospital of Firenze; Firenze; Italy
| | - M. Morfini
- Agency for Haemophilia; University Hospital of Firenze; Firenze
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MELCHIORRE DANIELA, MILIA ANNAFRANCA, LINARI SILVIA, ROMANO ELOISA, BENELLI GEMMA, MANETTI MIRKO, GUIDUCCI SERENA, CECCARELLI CLAUDIA, INNOCENTI MASSIMO, CARULLI CHRISTIAN, CIVININI ROBERTO, MORFINI MASSIMO, MATUCCI-CERINIC MARCO, IBBA-MANNESCHI LIDIA. RANK-RANKL-OPG in Hemophilic Arthropathy: From Clinical and Imaging Diagnosis to Histopathology. J Rheumatol 2012; 39:1678-86. [DOI: 10.3899/jrheum.120370] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Hemarthrosis triggers hemophilic arthropathy, involving the target joints. The histopathogenesis of blood-induced joint damage remains unclear. The triad of receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL), and osteoprotegerin (OPG; RANK-RANKL-OPG) controls bone turnover. Our aim was to evaluate RANK-RANKL-OPG expression in the synovium of hemophilic patients with severe arthropathy.Methods.Synovial biopsies were obtained from 18 patients with hemophilic arthropathy and 16 with osteoarthritis (OA) who were undergoing total knee replacement and synovectomy. The severity of hemophilic arthropathy was evaluated according to ultrasonography score, the World Federation of Hemophilia (WFH) orthopedic joint scale, and the radiographic Pettersson score. RANK-RANKL-OPG expression was examined by immunohistochemistry and Western blotting. Serum levels of soluble RANKL (sRANKL) and OPG from an extended group of 67 patients with hemophilic arthropathy and 30 healthy controls were measured by ELISA.Results.The mean ultrasonography, WFH orthopedic joint scale, and Pettersson scores in patients with hemophilic arthropathy indicated severe arthropathy. A decreased expression of OPG was found in hemophilic arthropathy synovium compared with patients with OA. RANK and RANKL immunopositivity was strong in the lining and sublining layers in hemophilic arthropathy synovial tissue. Western blotting confirmed the immunohistological findings. Serum levels of sRANKL and OPG in patients with hemophilia were lower than in healthy controls.Conclusion.In hemophilic arthropathy, the synovium highly expressed RANK and RANKL, whereas OPG immunopositivity decreased, suggesting an osteoclastic activation. Low tissue expression of OPG paralleled the serum levels of this protein and the severity of hemophilic arthropathy assessed by ultrasonography, Pettersson, and WFH orthopedic joint scale scores.
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Abstract
Bone density is a measure of equilibrium between bone formation and bone resorption; any imbalance in these two processes might lead to osteopenia and osteoporosis. Osteoporosis in general has been considered to be an important cause of morbidity in both men and women and more so in haemophilia and other bleeding disorders. Specific triggering factors in persons with haemophilia (PWH) are abnormal liver function because of viral infection, bleeding and inflammation, lack of physical and athletic activities, low body weight and others. Although the pathogenesis of osteoporosis is not clear, it has been considered as a severe comorbidity in PWH in both developing and developed countries. This is more evident in developing countries where there is no free access to factor concentrates, and primary prophylaxis is beyond the reach of vast majority of the patients. Only few references are available in the literature on the prevalence and management of osteoporosis in haemophilia population. This review summarises the prevalence, plausible mechanisms and management options of this important morbidity in PWH.
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Affiliation(s)
- Kanjaksha Ghosh
- National Institute of Immunohaematology, KEM Hospital, Parel, Mumbai, India.
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KRUSE-JARRES R, QUON D, SCHRAMM W, DOLAN G. Management of bleeding disorders in the elderly. Haemophilia 2012; 18 Suppl 2:37-45. [DOI: 10.1111/j.1365-2516.2012.02798.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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