title: Bone histomorphometry in children and adolescents with beta-thalassemia disease: iron-associated focal osteomalacia.
abstract: Thalassemia/hemoglobinopathy is a hereditary disease that causes chronic anemia and increased erythropoiesis. Consequently, an expansion of bone marrow spaces may contribute to osteopenia/osteoporosis. However, the pathogenesis of bone changes is not yet known. We, therefore, carried out the study on bone histomorphometry and biochemical and hormonal profiles in children and adolescents with suboptimally treated beta-thalassemia disease with the hope of gaining some new insight into the cellular and structural alterations of thalassemic bone. Seventeen patients underwent iliac crest bone biopsy for histomorphometric analyses. Bone mineral density (BMD) measurements were performed by dual energy x-ray absorptiometry. Most patients had growth retardation and delayed bone age. BMD was low especially at the lumbar spine. Serum IGF-I levels were almost always low. Bone histomorphometry revealed increased osteoid thickness, osteoid maturation time, and mineralization lag time, which indicate impaired bone matrix maturation and defective mineralization. In addition, iron deposits appeared along mineralization fronts and osteoid surfaces. Moreover, focal thickened osteoid seams were found together with focal iron deposits. Dynamic bone formation study revealed reduced bone formation rate. These findings indicate that delayed bone maturation and focal osteomalacia are the pathogenesis of bone disease in suboptimally blood-transfused thalassemics with iron overload. Iron deposits in bone and low circulating IGF-I levels may partly contribute to the above findings.
authors.affiliation: Departments of Pediatric, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. rapmw@mahidol.ac.th
authors.forename: Pat
authors.initials: P
authors.lastname: Mahachoklertwattana
authors.forename: Vorachai
authors.initials: V
authors.lastname: Sirikulchayanonta
authors.forename: Ampaiwan
authors.initials: A
authors.lastname: Chuansumrit
authors.forename: Patcharee
authors.initials: P
authors.lastname: Karnsombat
authors.forename: Lulin
authors.initials: L
authors.lastname: Choubtum
authors.forename: Arporn
authors.initials: A
authors.lastname: Sriphrapradang
authors.forename: Somnuek
authors.initials: S
authors.lastname: Domrongkitchaiporn
authors.forename: Rojana
authors.initials: R
authors.lastname: Sirisriro
authors.forename: Rajata
authors.initials: R
authors.lastname: Rajatanavin
mesh_terms: D000273:Adipose Tissue / Q000473:pathology / Q000502:physiology; D000293:Adolescent; D001823:Body Composition / Q000502:physiology; D015519:Bone Density; D001846:Bone Development / Q000502:physiology; D001842:Bone and Bones / Q000378:metabolism / Q000473:pathology*; D002648:Child; D005293:Ferritins / Q000378:metabolism; D006728:Hormones / Q000097:blood; D006801:Humans; D007501:Iron / Q000378:metabolism / Q000502:physiology*; D010018:Osteomalacia / Q000378:metabolism / Q000473:pathology*; D017086:beta-Thalassemia / Q000378:metabolism / Q000473:pathology*
chemical_list: D006728:Hormones; D005293:Ferritins; D007501:Iron