Hypovitaminosis D and osteopenia/osteoporosis in a haemophilia population: a study in HCV/HIV or HCV infected patients

Abstract

Summary. Recent reports show a correlation between haemophilia and osteoporosis. HIV, HCV and their treatments are independently associated with an increased risk of osteoporosis. Vitamin D plays a pivotal role in bone mineralization. The aim of our study was to compare Vitamin D levels, bone metabolism markers and bone mineral density (BMD) in patients with haemophilia with or without co-infections. Seventy-eight adult patients with severe or moderate haemophilia A or B were subdivided into three groups of 26 patients each (HIV-HCV co-infected, HCV mono-infected and uninfected). The BMD was measured by dual energy X-ray absorptiometry (DXA) at both the femoral area (F) and lumbar spine (L). This was correlated to laboratory values and haemophilic arthropathy was assessed using validated clinical and radiological scores. The DXA showed a homogeneous F-BMD reduction in all the three groups, whereas L-BMD was significantly lower in co-infected patients (P < 0.05). The clinical score was higher in co-infected (P < 0.002) and mono-infected (P < 0.006). The radiological score was higher in mono-infected than in the other two groups (P < 0.001). Overall 25-hydroxyvitamin D (25-OH Vit D) was reduced (87%). Bone-specific alkaline phosphatase (b-ALP) and telopeptide were increased in co-infected (P < 0.001 and P < 0.01) and mono-infected (P < 0.001 and P < 0.02). The result of the homogeneous F-BMD reduction in all groups could be explained by the pivotal role of arthropathy; the lower L-BMD in co-infected and the increase of b-ALP and telopeptide in co-infected and mono-infected groups suggest faster bone metabolism in case of infections.Keywords: osteoporosis, vitamin D, haemophilic arthropathy, HCV, HIV, HAART IntroductionRecent evidence suggests a strong correlation between osteoporosis and haemophilia. The pathogenesis of low bone mineral density (BMD) in patients with haemophilia is multi-factorial and primarily includes prolonged immobilization [1,2], lack of weight-bearing exercise [3] and an increased bone turnover mediated by pro-inflammatory cytokines and osteoclastogenesis activating factors [4,5]. Other factors such as HIV or HCV infections and their treatment may be independently associated with decreased BMD [1,4]. Osteoporosis is a disorder characterized by both quantitative and qualitative alterations that reduce bone strength [6]. Bone densitometry measured by dual X-ray absorptiometry scan (DXA) is the current gold standard test for assessing bone mineralization [7]. Biomarkers of bone formation and resorption reflecting the activity of osteoblasts and osteoclasts, respectively, have also been developed to increase knowledge on the bone turnover pathophysiology [8].A pivotal and well-established role in bone mineralization is played by vitamin D. In the last years, hypovitaminosis D has been shown to be extremely common and prevalent across all age groups, gender Haemophilia ( 2013 ), 19, 126-133 DOI: 10.1111 /j.1365 -2516 .2012 and geographic areas [9][10][11]. However, little data about the prevalen...

Effect of low‐dose factor VIII prophylaxis therapy on bone mineral density and 25(OH) vitamin D level in children with severe haemophilia A

“…Similarly, Albayrak et al found that 96% of haemophilia children had low vitamin D (68% deficiency and 28% insufficiency) with a mean vitamin D level of 16.35 ng/m, range (3.25‐33.80). Also, Gerstner et al, Linari et al and Anagnostis et al found that 67, 87 and 47%, respectively of adults with haemophilia had vitamin D deficiency, whereas Sanadhya and signh and Katsarou et al reported no difference from controls. This could be because their studies included patients with mild, moderate and severe haemophilia.…”

Vitamin D deficiency in patients with haemophilia: an underestimated commorbidity

“…The authors also reported that 87% of the entire study population was vitamin D deficient. This percentage was 100% in patients with HCV/HIV co-infection, 73% in those with HCV mono-infection and 88% in those not infected, without any significance among these three groups [1].…”

“…We would like to comment on these findings. First of all, the authors used Z-scores in all patients irrespective of their age, defining values between -1 and -2 standard deviation (SD) as 'osteopenia' and greater than À2 as 'osteoporosis' [1]. We disagree with these definitions.…”

Vitamin D deficiency and osteoporosis in hemophilic children

“…Gerstner et al [24] and Linari et al [25] investigated vitamin D levels in adult patients with hemophilia and reported deficiencies of 67 and 87%, respectively. Albayrak et al [20] reported vitamin D deficiency in 68% of pediatric patients.…”