Mehtap EVRAN OLGUN, Emel GÜRKAN, Abdullah TULİ

Zoledronik asit osteoporozlu β-talasemi hastalarında kemik mineral yoğunluğunu arttırır: Bir vaka kontrol çalışması

Amaç: Bu çalışmada osteoporozu olan β-talasemi hastalarında zoledronik asit tedavisinin etkinliği incelenmiştir.Gereç ve Yöntem: Çalışmaya 33 β-talasemili hasta ile kontrol grubu olarak yaş ve cinsiyetleri uyumlu 25 sağlıklı gönüllü alındı. Hastalarda 0. 6. ve 12.aylarda DEXA ve serum ve idrarda osteoporozun bazı biyokimyasal belirteçleri ölçüldü. Talasemili hastalar 12 ay süreyle her altı ayda bir 4 mg İV zoledronik asit ve 0.25 mcg/gün kalsitriol alanlar olmak üzere rastgele iki ayrı gruba ayrıldı. Gonadal fonksiyonlarına göre de iki alt gruba ayrılarak takip edildiler. Bulgular: Hastalar yaş ortalaması 23.1±1.3 ve kemik yaşı ortalaması 16.3±0.35 yıl olan 21 erkek, 18 kadından oluşmaktaydı. On iki ay sonunda zoledronik asit grubunda lumbar vertebra ve femur boynu kemik mineral yoğunluğu anlamlı artış gösterdi. Hipogonadik olup hormon replasmanı yapılan hastalarda lumbar vertebra ve femur boynu t-skoru anlamlı artış gösterdi. Serum NTX düzeyleri tedavinin sonunda her iki tedavi grubunda da kontrol grubuna göre belirgin olarak yükselme gösterdi. Hipogonadik hastalar içinde zolendronik asit alanlarda idrar NTXdüzeylerinde, normogonadik hastalar içinde kalsitriol alanlarda idrar NTX ve serum IGF-1 düzeylerinde anlamlı artış saptandı. Sonuç: Çalışmamızda zoledronik asit kemik mineral yoğunluğu ve t-skorlarında belirgin düzelmeler sağlamıştır. Bu düzelme IGF-1 düzeyi ile korelasyon göstermiştir.

Anahtar Kelimeler:

β-talasemi, zoledronik asit, osteoporoz, DEXA

Zoledronic acid improves bone mineral density in β-thalassemia patients with osteoporosis: a case control study

Purpose: This study addresses the efficacy of zoledronic acid treatment in osteoporotic patients with β-thalassemia.Materials and Methods: Thirty-nine thalassemic patients were enrolled in this study. Bone mineral density was measured using Dual energy x-ray absorbtiometry (DEXA), and biochemical markers of osteoporosis in serum and urine were measured at 0, 6, and 12 months of treatment. Patients with thalassemia were randomly received either zoledronic acid 4 mg IV once every six months or calcitriol 0.25 mcg / day for 12 months. A subgroup analysis was also performed according to gonadal status. Results: There were 21 males and 18 females, mean age of 23.1 ± 1.3 and bone age of 16.3±0.35 years. At the end of 12 months, bone mineral densities of the lumbar vertebra and femoral neck significantly increased in the zoledronic acid group. In patients with hypogonadism who received hormone replacement therapy, t-scores significantly increased. Serum NTX levels indicated significant increase in both treatment groups compared with the control group at the end of the treatment. A significant increase was obtained in urinary NTX level in hypogonadal patients who received zoledronic acid, and in serum NTX and IGF-1 levels in normogonadal patients who received calcitriol. Conclusion: In our study, zoledronic acid resulted in significant improvement in bone mineral density and t-scores. This improvement was in correlation with IGF-1 levels.

Keywords:

β-thalassemia, osteoporosis zoledronic acid, DEXA, serum and urinary NTX, IGF-I,

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