Effect of low dose pamidronate in the treatment of thalassemia-induced osteoporosis

Abstract

Introduction: Thalassemia is the most common genetic defect, globally affecting about 200 million individuals. Increased longevity in transfusion-dependent thalassemia patients is accompanied by complications such as osteopenia, osteoporosis and skeletal disabilities. In this regard, increased bone reabsorption in beta-thalassemia has led to the administration of bisphosphonates for these patients. Objectives: Although there is growing consensus on the effectiveness of pamidronate in thalassemia osteoporosis, the findings about the dosage and duration of pamidronate are inconsistent. Accordingly, the present study aimed to assess the impact of low-dose pamidronate on the bone mineral density (BMD) of major beta-thalassemia patients. Patients and Methods: In this study, the participants encompassed 20 transfusion-dependent major thalassemia patients with Z-score< -2.5 in bone mineral densitometry. Bone density was determined in the lumbar vertebras and hip by using dual X-ray absorptiometry. Pamidronate was administered intravenously in monthly dosage of 1 mg/kg over six months. Results: According to the findings, the participants’ mean age was 16.55±3.15 years (Range: 10-25 years). The baseline mean of Z-score for lumbar vertebras was -2.92±1.14 and reached -1.95±1.2 after six months (P<0.001). Moreover, the baseline mean of Z-score for the hip region was -2.00 (0.65) and reached -1.55 (0.77). Conclusion: The dosages of 1 mg/kg over six months had a statistically significant effect on bone density and improved Z-scores of lumbar vertebrae and hip bone density by 45% and 20%, respectively.