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The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?

Hemolytic anemia (HA) renders erythropoietic stress on the bone marrow and has been linked to osteoporosis. In this nationwide retrospective cohort study, we examined this correlation by utilizing the Taiwan National Health Insurance Research Database (NHIRD). We identified two cohorts, matching pop...

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Autores principales: Shi, Leiyu, Lin, Cheng-Li, Su, Ching-Huang, Lin, Keng-Chian, Leong, Kam-Hang, Wang, Yu-Ting Tina, Kuo, Chien-Feng, Tsai, Shin-Yi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348015/
https://www.ncbi.nlm.nih.gov/pubmed/34362147
http://dx.doi.org/10.3390/jcm10153364
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author Shi, Leiyu
Lin, Cheng-Li
Su, Ching-Huang
Lin, Keng-Chian
Leong, Kam-Hang
Wang, Yu-Ting Tina
Kuo, Chien-Feng
Tsai, Shin-Yi
author_facet Shi, Leiyu
Lin, Cheng-Li
Su, Ching-Huang
Lin, Keng-Chian
Leong, Kam-Hang
Wang, Yu-Ting Tina
Kuo, Chien-Feng
Tsai, Shin-Yi
author_sort Shi, Leiyu
collection PubMed
description Hemolytic anemia (HA) renders erythropoietic stress on the bone marrow and has been linked to osteoporosis. In this nationwide retrospective cohort study, we examined this correlation by utilizing the Taiwan National Health Insurance Research Database (NHIRD). We identified two cohorts, matching population with and without HA in a 1:4 ratio. A total of 2242 HA patients and 8968 non-HA patients were enrolled. Patients with HA had a significantly higher cumulative incidence (log-rank test p = 0.0073), higher incidence density (5.11 vs. 3.76 per 1000 persons-years), and a 1.31-fold risk of developing osteoporosis than non-HA patients (aHR = 1.31, 95% C.I. 1.04–1.63, p = 0.01). After adjusting for age, sex, and comorbidities, patients with factors including female (aHR = 2.57, 95% C.I. 2.05–3.22, p < 0.001), age > 65 (aHR = 9.25, 95% C.I. 7.46–11.50, p < 0.001), diagnosis of cholelithiasis (aHR = 1.76, 95% C.I. 1.20–2.58, p = 0.003) and peptic ulcer disease (aHR = 1.87, 95% C.I. 1.52–2.29, p < 0.001) had significantly higher risk of osteoporosis. We propose that this correlation may be related to increased hematopoietic stress, increased consumption of nitric oxide (NO) by hemolysis, and the inhibitory effects of iron supplements on osteogenesis through the receptor activator of nuclear factor κB ligand (RANKL)/Osteoprotegerin pathway and the Runt-related transcription factor 2 (RUNX2) factor. Our findings suggest that patients with hemolytic anemia are at a higher risk of developing osteoporosis, and it would be in the patient’s best interest for physicians to be aware of this potential complication and offer preventative measures.
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spelling pubmed-83480152021-08-08 The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss? Shi, Leiyu Lin, Cheng-Li Su, Ching-Huang Lin, Keng-Chian Leong, Kam-Hang Wang, Yu-Ting Tina Kuo, Chien-Feng Tsai, Shin-Yi J Clin Med Article Hemolytic anemia (HA) renders erythropoietic stress on the bone marrow and has been linked to osteoporosis. In this nationwide retrospective cohort study, we examined this correlation by utilizing the Taiwan National Health Insurance Research Database (NHIRD). We identified two cohorts, matching population with and without HA in a 1:4 ratio. A total of 2242 HA patients and 8968 non-HA patients were enrolled. Patients with HA had a significantly higher cumulative incidence (log-rank test p = 0.0073), higher incidence density (5.11 vs. 3.76 per 1000 persons-years), and a 1.31-fold risk of developing osteoporosis than non-HA patients (aHR = 1.31, 95% C.I. 1.04–1.63, p = 0.01). After adjusting for age, sex, and comorbidities, patients with factors including female (aHR = 2.57, 95% C.I. 2.05–3.22, p < 0.001), age > 65 (aHR = 9.25, 95% C.I. 7.46–11.50, p < 0.001), diagnosis of cholelithiasis (aHR = 1.76, 95% C.I. 1.20–2.58, p = 0.003) and peptic ulcer disease (aHR = 1.87, 95% C.I. 1.52–2.29, p < 0.001) had significantly higher risk of osteoporosis. We propose that this correlation may be related to increased hematopoietic stress, increased consumption of nitric oxide (NO) by hemolysis, and the inhibitory effects of iron supplements on osteogenesis through the receptor activator of nuclear factor κB ligand (RANKL)/Osteoprotegerin pathway and the Runt-related transcription factor 2 (RUNX2) factor. Our findings suggest that patients with hemolytic anemia are at a higher risk of developing osteoporosis, and it would be in the patient’s best interest for physicians to be aware of this potential complication and offer preventative measures. MDPI 2021-07-29 /pmc/articles/PMC8348015/ /pubmed/34362147 http://dx.doi.org/10.3390/jcm10153364 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shi, Leiyu
Lin, Cheng-Li
Su, Ching-Huang
Lin, Keng-Chian
Leong, Kam-Hang
Wang, Yu-Ting Tina
Kuo, Chien-Feng
Tsai, Shin-Yi
The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?
title The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?
title_full The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?
title_fullStr The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?
title_full_unstemmed The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?
title_short The Risk of Developing Osteoporosis in Hemolytic Anemia—What Aggravates the Bone Loss?
title_sort risk of developing osteoporosis in hemolytic anemia—what aggravates the bone loss?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348015/
https://www.ncbi.nlm.nih.gov/pubmed/34362147
http://dx.doi.org/10.3390/jcm10153364
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