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Osteoporosis International

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01-02-2014 | Original Article

The effect of gonadal status on body composition and bone mineral density in transfusion-dependent thalassemia

Authors: P. Wong, P. J. Fuller, M. T. Gillespie, V. Kartsogiannis, F. Milat, D. K. Bowden, B. J. Strauss

Published in: Osteoporosis International | Issue 2/2014

Abstract

Summary

Patients with transfusion-dependent thalassemia have abnormal growth, hormonal deficits, and increased bone loss. We investigated the relationship between skeletal muscle mass, fat mass, and bone mineral density in adult subjects with transfusion-dependent thalassemia based on their gonadal status. Our findings show that hypogonadism attenuates the strength of the muscle–bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects.

Introduction

Transfusion-dependent thalassemia is associated with a high prevalence of fractures. Multiple hormonal complications, in particular hypogonadism, can lead to changes in body composition and bone mineral density (BMD). We investigated for the first time the relationship between skeletal muscle mass (SMM), fat mass, and BMD in adult subjects with transfusion-dependent thalassemia based on their gonadal status.

Methods

A retrospective cohort study of 186 adults with transfusion-dependent thalassemia was analyzed. Body composition and BMD were measured using dual energy X-ray absorptiometry. The association between skeletal muscle, fat, and BMD was investigated through uni-, multi-, and stepwise regression analyses after adjusting for multicollinearity. SMM was derived using the formula, SMM = 1.19 × ALST−1.65, where ALST is equivalent to the sum of both arm and leg lean tissue mass.

Results

There were 186 subjects, males (43.5 %) and females (56.5 %), with a median age of 36.5. Hypogonadism was reported in 44.4 % of males and 44.7 % of females. SMM and BMD were positively correlated and strongest in eugonadal males (0.36 ≤ R ² ≤ 0.59), but the association was attenuated in hypogonadal males. SMM (0.27 ≤ R ² ≤ 0.69) and total fat mass (0.26 ≤ R ² ≤ 0.55) were positively correlated with BMD in hypogonadal females, but the correlation was less pronounced in eugonadal females. Leg lean tissue mass and arm lean tissue mass in males and females, respectively, were most highly correlated to BMD in the stepwise regression analysis.

Conclusion

Hypogonadism attenuates the strength of the muscle–bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects. This study supports the notion that exercise is important for maintaining BMD and the need to optimize treatment of hypogonadism in patients with transfusion-dependent thalassemia.

Gamberini MR, De Sanctis V, Gilli G (2008) Hypogonadism, diabetes mellitus, hypothyroidism, hypoparathyroidism: incidence and prevalence related to iron overload and chelation therapy in patients with thalassaemia major followed from 1980 to 2007 in the Ferrara Centre. Pediatr Endocrinol Rev 1:158–169

Italian Working Group on Endocrine Complications in Non-endocrine Diseases (1995) Multicentre study on prevalence of endocrine complications in thalassaemia major. Clin Endocrinol 42:581–586CrossRef

Roth C, Pekrun A, Bartz M, Jarry H, Eber S, Lakomek M, Schröten W (1997) Short stature and failure of pubertal development in thalassaemia major: evidence for hypothalamic neurosecretory dysfunction of growth hormone secretion and defective pituitary gonadotropin secretion. Eur J Pediatr 156:777–783PubMedCrossRef

Rodda CP, Reid ED, Johnson S, Doery J, Matthews R, Bowden DK (1995) Short stature in homozygous β-thalassaemia is due to disproportionate truncal shortening. Clin Endocrinol 42:587–592CrossRef

Fung EB, Xu Y, Kwiatkowski JL, Vogiatzi MG, Neufeld E, Olivieri N, Vichinsky EP, Giardina PJ (2010) Relationship between chronic transfusion therapy and body composition in subjects with thalassemia. J Pediatr 157:641–647PubMedCentralPubMedCrossRef

Bogl LH, Latvala A, Kaprio J, Sovijärvi O, Rissanen A, Pietiläinen KH (2011) An investigation into the relationship between soft tissue body composition and bone mineral density in a young adult twin sample. J Bone Miner Res 26:79–87PubMedCrossRef

Compston JE, Bhambhani M, Laskey MA, Murphy S, Khaw KT (1992) Body composition and bone mass in postmenopausal women. Clin Endocrinol 37:426–431CrossRef

Kerr DA, Papalia S, Morton A, Dick I, Dhaliwal S, Prince RL (2007) Bone mass in young women is dependent on lean body mass. J Clin Densitom 10:319–326PubMedCrossRef

Reid IR (2010) Fat and bone. Arch Biochem Biophys 503:20–27PubMedCrossRef

10.

Khosla S, Atkinson EJ, Riggs BL, Melton Iii LJ (1996) Relationship between body composition and bone mass in women. J Bone Miner Res 11:857–863PubMedCrossRef

11.

Vogiatzi MG, Macklin EA, Fung EB et al (2009) Bone disease in Thalassemia: a frequent and still unresolved problem. J Bone Miner Res 24:543–557PubMedCrossRef

12.

Kim J, Heshka S, Gallagher D, Kotler DP, Mayer L, Albu J, Shen W, Freda PU, Heymsfield SB (2004) Intermuscular adipose tissue-free skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in adults. J Appl Physiol 97:655–660PubMedCrossRef

13.

Shamshirsaz AB, Bekheirnia MR, Kamgar M et al (2003) Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocr Disord 3(1):4PubMedCentralPubMedCrossRef

14.

Travison TG, Araujo AB, Esche GR, Beck TJ, McKinlay JB (2008) Lean mass and not fat mass is associated with male proximal femur strength. J Bone Miner Res 23:189–198PubMedCrossRef

15.

Lim S, Joung H, Shin CS, Lee HK, Kim KS, Shin EK, Kim HY, Lim MK, Cho SI (2004) Body composition changes with age have gender-specific impacts on bone mineral density. Bone 35:792–798PubMedCrossRef

16.

Snyder PJ, Peachey H, Hannoush P et al (1999) Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab 84:2647–2653PubMed

17.

Falahati-Nini A, Riggs BL, Atkinson EJ, O'Fallon WM, Eastell R, Khosla S (2000) Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. J Clin Investig 106:1553–1560PubMedCrossRef

18.

Reid IR, Plank LD, Evans MC (1992) Fat mass is an important determinant of whole body bone density in premenopausal women but not in men. J Clin Endocrinol Metab 75:779–782PubMed

19.

Ijuin M, Douchi T, Matsuo T, Yamamoto S, Uto H, Nagata Y (2002) Difference in the effects of body composition on bone mineral density between pre- and postmenopausal women. Maturitas 43:239–244PubMedCrossRef

20.

Reid IR, Ames R, Evans MC, Sharpe S, Gamble G, France JT, Lim TMT, Cundy TF (1992) Determinants of total body and regional bone mineral density in normal postmenopausal women—a key role for fat mass. J Clin Endocrinol Metab 75:45–51PubMed

21.

Thomas T, Burguera B, Melton LJ III, Atkinson EJ, O'Fallon WM, Riggs BL, Khosla S (2001) Role of serum leptin, insulin, and estrogen levels as potential mediators of the relationship between fat mass and bone mineral density in men versus women. Bone 29:114–120PubMedCrossRef

22.

Cornish J, Callon KE, Cooper GJS, Reid IR (1995) Amylin stimulates osteoblast proliferation and increases mineralized bone volume in adult mice. Biochem Biophys Res Commun 207:133–139PubMedCrossRef

23.

Thomas T, Burguera B (2002) Is leptin the link between fat and bone mass? J Bone Miner Res 17:1563–1569PubMedCrossRef

24.

Carmina E, Di Fede G, Napoli N, Renda G, Vitale G, Lo Pinto C, Bruno D, Malizia R, Rini GB (2004) Hypogonadism and hormone replacement therapy on bone mass of adult women with thalassemia major. Calcif Tissue Int 74:68–71PubMedCrossRef

25.

Reid IR, Legge M, Stapleton JP, Evans MC, Grey AB (1995) Regular exercise dissociates fat mass and bone density in premenopausal women. J Clin Endocrinol Metab 80:1764–1768PubMed

Title: The effect of gonadal status on body composition and bone mineral density in transfusion-dependent thalassemia
Authors: P. Wong
P. J. Fuller
M. T. Gillespie
V. Kartsogiannis
F. Milat
D. K. Bowden
B. J. Strauss
Publication date: 01-02-2014
Publisher: Springer London
Published in: Osteoporosis International / Issue 2/2014
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-013-2454-y

2024 ASCO Annual Meeting

Springer Medicine

The effect of gonadal status on body composition and bone mineral density in transfusion-dependent thalassemia

Abstract

Summary

Introduction

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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