Advertisement

Comparative effectiveness of alendronate and zoledronic acid on bone mass improvement in transfusion-dependent thalassemia patients

  • Omid Reza Zekavat
  • Mohamadreza Bordbar
  • Sezaneh Haghpanah
  • Forough Saki
  • Asghar Bazrafshan
  • Haleh BozorgiEmail author
Original Article
  • 56 Downloads

Abstract

Thalassemia, as the most prevalent genetic blood disorder, has many associated comorbidities including low bone mass. We studied the comparative effectiveness of alendronate (AL) and zoledronic acid (ZOL) on bone mass improvement in transfusion-dependent thalassemia (TDT) patients a year after treatment. Three hundred seventy-five TDT patients with low bone mass were enrolled in this study. After a year of treatment with either AL or ZOL, a second bone mineral density (BMD) test was ordered to compare the effectiveness of the two aforementioned drugs. Body mass index (BMI), physical activity, sun exposure, and biochemical laboratory data were also considered as associated factors in this study. The BMD test of both groups was almost the same at the baseline and it increased comparably after a year of treatment with AL and ZOL. However, there was a significant difference in lumbar spine BMD delta Z score between both groups of female patients. ZOL was more effective in increasing the lumbar spine BMD of female patients. The choice of bisphosphonates therapy (oral versus parenteral) should be individually selected by considering patient’s preference, compliance and the physician’s decision. Given the longer administration interval, and TDT patients’ compliance issue, it is justified to recommend ZOL as the drug of choice for patients suffering from low bone mass.

Keywords

Bone density Beta-thalassemia Alendronate Zoledronic acid 

Notes

Acknowledgement

This study was produced as a part of Haleh Bozorgi doctoral thesis with the specified grant number of 15195 provided by Shiraz University of Medical Science. We thank Shirin Parand at the Hematology Research Center for preparation of the manuscript. The authors wish to thank Sara Dadashzadeh and Mr. H. Argasi at the Research Consultation Center (RCC) of Shiraz University of Medical Sciences for his invaluable assistance in editing this manuscript.

Compliance with ethical standards

Conflict of interest

Omid Reza Zekavat, Mohamadreza Bordbar, Sezaneh Haghpanah, Forough Saki, Asghar Bazrafshan and Haleh Bozorgi declare that they have no conflict of interest.

References

  1. 1.
    Maheri A, Sadeghi R, Shojaeizadeh D, Tol A, Yaseri M, Ebrahimi M (2016) Associations between a healthpromoting lifestyle and quality of life among adults with beta-thalassemia major. Epidemiol Health 38Google Scholar
  2. 2.
    Dhirar N, Khandekar J, Bachani D, Mahto D (2016) Thalassemia major: how do we improve quality of life? SpringerPlus 5:1895CrossRefGoogle Scholar
  3. 3.
    Hassan MAM, Tolba OA (2016) Iron chelation monotherapy in transfusion-dependent beta-thalassemia major patients: a comparative study of deferasirox and deferoxamine. Electron Phys 8:2425CrossRefGoogle Scholar
  4. 4.
    Giusti A (2014) Bisphosphonates in the management of thalassemia-associated osteoporosis: a systematic review of randomised controlled trials. J Bone Miner Metab 32:606–615CrossRefGoogle Scholar
  5. 5.
    Morabito N, Gaudio A, Lasco A, Atteritano M, Pizzoleo MA, Cincotta M, La Rosa M, Guarino R, Meo A, Frisina N (2004) Osteoprotegerin and RANKL in the pathogenesis of thalassemia-induced osteoporosis: new pieces of the puzzle. J Bone Miner Res 19:722–727CrossRefGoogle Scholar
  6. 6.
    Gaudio A, Morabito N, Xourafa A, Macri I, Meo A, Morgante S, Trifiletti A, Lasco A, Frisina N (2008) Bisphosphonates in the treatment of thalassemia-associated osteoporosis. J Endocrinol Investig 31:181–184CrossRefGoogle Scholar
  7. 7.
    Gilfillan C, Strauss B, Rodda C, Bowden D, Kean A-M, Obaid M, Crawford B (2006) A randomized, double-blind, placebo-controlled trial of intravenous zoledronic acid in the treatment of thalassemia-associated osteopenia. Calcif Tissue Int 79:138–144.  https://doi.org/10.1007/s00774-019-01003-1 CrossRefGoogle Scholar
  8. 8.
    Voskaridou E, Terpos E, Spina G, Palermos J, Rahemtulla A, Loutradi A, Loukopoulos D (2003) Pamidronate is an effective treatment for osteoporosis in patients with beta-thalassaemia. Br J Haematol 123:730–737CrossRefGoogle Scholar
  9. 9.
    Tsartsalis AN, Lambrou GI, Tsartsalis D, Savvidis C, Karantza M, Terpos E, Kanaka-Gantenbein C, Chrousos GP, Kattamis A (2018) The role of biphosphonates in the management of thalassemia-induced osteoporosis: a systematic review and metaanalysis. Hormones 1–14Google Scholar
  10. 10.
    Voskaridou E, Terpos E (2004) New insights into the pathophysiology and management of osteoporosis in patients with beta thalassaemia. Br J Haematol 127:127–139CrossRefGoogle Scholar
  11. 11.
    Sarrai M, Duroseau H, D‘Augustine J, Moktan S, Bellevue R (2007) Bone mass density in adults with sickle cell disease. Br J Haematol 136:666–672CrossRefGoogle Scholar
  12. 12.
    Ravn P, Weiss SR, Rodriguez-Portales JA, McClung MR, Wasnich RD, Gilchrist NL, Sambrook P, Fogelman I, Krupa D, Yates AJ (2000) Alendronate in early postmenopausal women: effects on bone mass during long-term treatment and after withdrawal. J Clin Endocrinol Metab 85:1492–1497Google Scholar
  13. 13.
    Rosen CJ, Gallagher JC (2011) The 2011 IOM report on vitamin D and calcium requirements for north america: clinical implications for providers treating patients with low bone mineral density (in eng). J Clin Densitom 14:79–84.  https://doi.org/10.1016/j.jocd.2011.03.004 CrossRefGoogle Scholar
  14. 14.
    Lim JU, Lee JH, Kim JS, Hwang YI, Kim TH, Lim SY, Yoo KH, Jung KS, Kim YK, Rhee CK (2017) Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. Int J Chron Obstruct Pulmon Dis 12:2465–2475.  https://doi.org/10.2147/copd.s141295 CrossRefGoogle Scholar
  15. 15.
    De Sanctis V, Soliman AT, Elsefdy H, Soliman N, Bedair E, Fiscina B, Kattamis C (2017) Bone disease in β thalassemia patients: past, present and future perspectives. MetabolismGoogle Scholar
  16. 16.
    Terpos E, Voskaridou E (2010) Treatment options for thalassemia patients with osteoporosis. Ann N Y Acad Sci 1202:237–243CrossRefGoogle Scholar
  17. 17.
    Jensen C, Tuck S, Agnew J, Koneru S, Morris R, Yardumian A, Prescott E, Hoffbrand A, Wonke B (1998) High prevalence of low bone mass in thalassaemia major. Br J Haematol 103:911–915CrossRefGoogle Scholar
  18. 18.
    Duan Y, De Luca V, Seeman E (1999) Parathyroid hormone deficiency and excess: similar effects on trabecular bone but differing effects on cortical bone. J Clin Endocrinol Metab 84:718–722CrossRefGoogle Scholar
  19. 19.
    Orwoll ES, Miller PD, Adachi JD, Brown J, Adler RA, Kendler D, Bucci-Rechtweg C, Readie A, Mesenbrink P, Weinstein RS (2010) Efficacy and safety of a once-yearly iv infusion of zoledronic acid 5 mg versus a once–weekly 70-mg oral alendronate in the treatment of male osteoporosis: a randomized, multicenter, double-blind, active-controlled study. J Bone Miner Res 25:2239–2250CrossRefGoogle Scholar
  20. 20.
    Perrotta S, Cappellini MD, Bertoldo F, Servedio V, Iolascon G, D'agruma L, Gasparini P, Siciliani MC, Iolascon A, (2000) Osteoporosis in β- thalassaemia major patients: analysis of the genetic background. Br J Haematol 111:461–466.  https://doi.org/10.1007/s00774-019-01003-1 CrossRefGoogle Scholar
  21. 21.
    Pollak RD, Rachmilewitz E, Blumenfeld A, Idelson M, Goldfarb AW (2000) Bone mineral metabolism in adults with β-thalassaemia major and intermedia. Br J Haematol 111:902–907Google Scholar
  22. 22.
    Saag K, Lindsay R, Kriegman A, Beamer E, Zhou W (2007) A single zoledronic acid infusion reduces bone resorption markers more rapidly than weekly oral alendronate in postmenopausal women with low bone mineral density. Bone 40:1238–1243CrossRefGoogle Scholar
  23. 23.
    Shirani F, Shahriari-Ahmadi A, Arabi M, Asefi N (2015) Evaluation of alendronate efficacy on bone mineral density in thalassemic patients. Int J Hematol-Oncol Stem Cell Res 6:20–24Google Scholar
  24. 24.
    Morabito N, Lasco A, Gaudio A, Crisafulli A, Di Pietro C, Meo A, Frisina N (2002) Bisphosphonates in the treatment of thalassemia-induced osteoporosis. Osteoporos Int 13:644–649CrossRefGoogle Scholar
  25. 25.
    Boonen S, Orwoll E, Magaziner J, Colón-Emeric CS, Adachi JD, Bucci-Rechtweg C, Haentjens P, Kaufman JM, Rizzoli R, Vanderschueren D (2011) Once-yearly zoledronic acid in older men compared with women with recent hip fracture. J Am Geriatr Soc 59:2084–2090CrossRefGoogle Scholar
  26. 26.
    McClung M, Miller P, Recknor C, Mesenbrink P, Bucci-Rechtweg C, Benhamou CL (2009) Zoledronic acid for the prevention of bone loss in postmenopausal women with low bone mass: a randomized controlled trial. Obstet Gynecol 114:999–1007.  https://doi.org/10.1097/AOG.0b013e3181bdce0a CrossRefGoogle Scholar
  27. 27.
    Perifanis V, Vyzantiadis T, Tziomalos K, Vakalopoulou S, Garipidou V, Athanassiou-Metaxa M, Harsoulis F (2007) Effect of zoledronic acid on markers of bone turnover and mineral density in osteoporotic patients with beta-thalassaemia. Ann Hematol 86:23–30CrossRefGoogle Scholar
  28. 28.
    Voskaridou E, Christoulas D, Konstantinidou M, Tsiftsakis E, Alexakos P, Terpos E (2008) Continuous improvement of bone mineral density two years post zoledronic acid discontinuation in patients with thalassemia-induced osteoporosis: long-term follow-up of a randomized, placebo-controlled trial. Haematologica 93:1588–1590CrossRefGoogle Scholar
  29. 29.
    Otrock ZK, Azar ST, Shamseddeen WA, Habr D, Inati A, Koussa S, Mahfouz RA, Taher AT (2006) Intravenous zoledronic acid treatment in thalassemia-induced osteoporosis: results of a phase II clinical trial. Ann Hematol 85:605–609CrossRefGoogle Scholar
  30. 30.
    Piscitelli P, Auriemma R, Neglia C, Migliore A (2014) Alendronate: new formulations of an old and effective drug to improve adherence avoiding upper gastrointestinal side effects. Eur Rev Med Pharmacol Sci 18:3788–3796Google Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Hematology Research Centre, Nemazee HospitalShiraz University of Medical SciencesShirazIran
  2. 2.Endocrinology and Metabolism Research CenterShiraz University of Medical SciencesShirazIran

Personalised recommendations