Bone turnover and mineral density in adult thalassemic patients

relationships with growth hormone secretory status and circulating somatomedins

Massimo Scacchi, Leila Danesi, A. Cattaneo, Giovanna Sciortino, Raffaella Radin, Alberto Giacinto Ambrogio, Giovanni Vitale, Emanuela Stefania D'Angelo, Nadia Anna Mirra, Laura Zanaboni, Marica Arvigo, Mara Boschetti, Diego Ferone, Paolo Marzullo, Itala Marina Baldini, Elena Cassinerio, Maria Domenica Cappellini, Luca Persani, Francesco Cavagnini

Research output: Contribution to journalArticle

Abstract

Previous evidence supports a role for growth hormone (GH)–insulin-like growth factor (IGF)-I deficiency in the pathophysiology of osteopenia/osteoporosis in adult thalassemia. Moreover, serum IGF-II has never been studied in this clinical condition. Thus, we elected to study the GH secretory status and the levels of circulating somatomedins, correlating these parameters with bone mineral density (BMD) and biochemical markers of bone turnover. A hundred and thirty-nine normal weight adult thalassemic patients (72 men and 67 women) were studied. Lumbar and femoral neck BMD were measured in 106/139 patients. Sixty-eight patients underwent growth hormone releasing hormone plus arginine testing. Measurement of baseline IGF-I and IGF-II was performed in all patients, while osteocalcin, C-terminal telopeptide of type I collagen (CTx), and urinary cross-linked N-telopeptides of type I collagen (NTx) were assayed in 95 of them. Femoral and lumbar osteoporosis/Z score below the expected range for age were documented in 61.3 and in 56.6 % of patients, respectively. Severe GH deficiency (GHD) was demonstrated in 27.9 % of cases, whereas IGF-I SDS was low in 86.3 %. No thalassemic patients displayed circulating levels of IGF-II below the reference range. GH peaks were positively correlated with femoral, but not lumbar, Z score. No correlations were found between GH peaks and osteocalcin, CTx and NTx. GH peaks were positively correlated with IGF-I values, which in their turn displayed a positive correlation with osteocalcin, CTx, and NTx. No correlations emerged between IGF-I values and either femoral or lumbar Z scores. No correlations were found between IGF-II and any of the following parameters: GH peaks, osteocalcin, CTx, NTx, femoral Z score, and lumbar Z score. Our study, besides providing for the first time evidence of a normal IGF-II production in thalassemia, contributes to a better understanding of the involvement of the somatotropin-somatomedin axis in the pathophysiology of bone demineralization in this disease. In particular, the contribution of GHD to femoral osteoporosis appears to be likely mediated by locally produced rather than circulating IGF-I.

Original languageEnglish
Pages (from-to)551-557
Number of pages7
JournalEndocrine
Volume53
Issue number2
DOIs
Publication statusPublished - 2016

Fingerprint

Bone Remodeling
Somatomedins
Bone Density
Growth Hormone
Insulin-Like Growth Factor II
Thigh
Insulin-Like Growth Factor I
Osteocalcin
Osteoporosis
Thalassemia
Growth Hormone-Releasing Hormone
Metabolic Bone Diseases
Femur Neck
Collagen Type I
Arginine
Reference Values
Biomarkers
Weights and Measures
Bone and Bones
Serum

Keywords

  • Growth hormone
  • IGF-I
  • IGF-II
  • Thalassemia

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

@article{06c9e7d0ae1c48bc8e7c20758274ea11,
title = "Bone turnover and mineral density in adult thalassemic patients: relationships with growth hormone secretory status and circulating somatomedins",
abstract = "Previous evidence supports a role for growth hormone (GH)–insulin-like growth factor (IGF)-I deficiency in the pathophysiology of osteopenia/osteoporosis in adult thalassemia. Moreover, serum IGF-II has never been studied in this clinical condition. Thus, we elected to study the GH secretory status and the levels of circulating somatomedins, correlating these parameters with bone mineral density (BMD) and biochemical markers of bone turnover. A hundred and thirty-nine normal weight adult thalassemic patients (72 men and 67 women) were studied. Lumbar and femoral neck BMD were measured in 106/139 patients. Sixty-eight patients underwent growth hormone releasing hormone plus arginine testing. Measurement of baseline IGF-I and IGF-II was performed in all patients, while osteocalcin, C-terminal telopeptide of type I collagen (CTx), and urinary cross-linked N-telopeptides of type I collagen (NTx) were assayed in 95 of them. Femoral and lumbar osteoporosis/Z score below the expected range for age were documented in 61.3 and in 56.6 {\%} of patients, respectively. Severe GH deficiency (GHD) was demonstrated in 27.9 {\%} of cases, whereas IGF-I SDS was low in 86.3 {\%}. No thalassemic patients displayed circulating levels of IGF-II below the reference range. GH peaks were positively correlated with femoral, but not lumbar, Z score. No correlations were found between GH peaks and osteocalcin, CTx and NTx. GH peaks were positively correlated with IGF-I values, which in their turn displayed a positive correlation with osteocalcin, CTx, and NTx. No correlations emerged between IGF-I values and either femoral or lumbar Z scores. No correlations were found between IGF-II and any of the following parameters: GH peaks, osteocalcin, CTx, NTx, femoral Z score, and lumbar Z score. Our study, besides providing for the first time evidence of a normal IGF-II production in thalassemia, contributes to a better understanding of the involvement of the somatotropin-somatomedin axis in the pathophysiology of bone demineralization in this disease. In particular, the contribution of GHD to femoral osteoporosis appears to be likely mediated by locally produced rather than circulating IGF-I.",
keywords = "Growth hormone, IGF-I, IGF-II, Thalassemia",
author = "Massimo Scacchi and Leila Danesi and A. Cattaneo and Giovanna Sciortino and Raffaella Radin and Ambrogio, {Alberto Giacinto} and Giovanni Vitale and D'Angelo, {Emanuela Stefania} and Mirra, {Nadia Anna} and Laura Zanaboni and Marica Arvigo and Mara Boschetti and Diego Ferone and Paolo Marzullo and Baldini, {Itala Marina} and Elena Cassinerio and Cappellini, {Maria Domenica} and Luca Persani and Francesco Cavagnini",
year = "2016",
doi = "10.1007/s12020-016-0865-1",
language = "English",
volume = "53",
pages = "551--557",
journal = "Endocrine",
issn = "1355-008X",
publisher = "Humana Press Inc.",
number = "2",

}

TY - JOUR

T1 - Bone turnover and mineral density in adult thalassemic patients

T2 - relationships with growth hormone secretory status and circulating somatomedins

AU - Scacchi, Massimo

AU - Danesi, Leila

AU - Cattaneo, A.

AU - Sciortino, Giovanna

AU - Radin, Raffaella

AU - Ambrogio, Alberto Giacinto

AU - Vitale, Giovanni

AU - D'Angelo, Emanuela Stefania

AU - Mirra, Nadia Anna

AU - Zanaboni, Laura

AU - Arvigo, Marica

AU - Boschetti, Mara

AU - Ferone, Diego

AU - Marzullo, Paolo

AU - Baldini, Itala Marina

AU - Cassinerio, Elena

AU - Cappellini, Maria Domenica

AU - Persani, Luca

AU - Cavagnini, Francesco

PY - 2016

Y1 - 2016

N2 - Previous evidence supports a role for growth hormone (GH)–insulin-like growth factor (IGF)-I deficiency in the pathophysiology of osteopenia/osteoporosis in adult thalassemia. Moreover, serum IGF-II has never been studied in this clinical condition. Thus, we elected to study the GH secretory status and the levels of circulating somatomedins, correlating these parameters with bone mineral density (BMD) and biochemical markers of bone turnover. A hundred and thirty-nine normal weight adult thalassemic patients (72 men and 67 women) were studied. Lumbar and femoral neck BMD were measured in 106/139 patients. Sixty-eight patients underwent growth hormone releasing hormone plus arginine testing. Measurement of baseline IGF-I and IGF-II was performed in all patients, while osteocalcin, C-terminal telopeptide of type I collagen (CTx), and urinary cross-linked N-telopeptides of type I collagen (NTx) were assayed in 95 of them. Femoral and lumbar osteoporosis/Z score below the expected range for age were documented in 61.3 and in 56.6 % of patients, respectively. Severe GH deficiency (GHD) was demonstrated in 27.9 % of cases, whereas IGF-I SDS was low in 86.3 %. No thalassemic patients displayed circulating levels of IGF-II below the reference range. GH peaks were positively correlated with femoral, but not lumbar, Z score. No correlations were found between GH peaks and osteocalcin, CTx and NTx. GH peaks were positively correlated with IGF-I values, which in their turn displayed a positive correlation with osteocalcin, CTx, and NTx. No correlations emerged between IGF-I values and either femoral or lumbar Z scores. No correlations were found between IGF-II and any of the following parameters: GH peaks, osteocalcin, CTx, NTx, femoral Z score, and lumbar Z score. Our study, besides providing for the first time evidence of a normal IGF-II production in thalassemia, contributes to a better understanding of the involvement of the somatotropin-somatomedin axis in the pathophysiology of bone demineralization in this disease. In particular, the contribution of GHD to femoral osteoporosis appears to be likely mediated by locally produced rather than circulating IGF-I.

AB - Previous evidence supports a role for growth hormone (GH)–insulin-like growth factor (IGF)-I deficiency in the pathophysiology of osteopenia/osteoporosis in adult thalassemia. Moreover, serum IGF-II has never been studied in this clinical condition. Thus, we elected to study the GH secretory status and the levels of circulating somatomedins, correlating these parameters with bone mineral density (BMD) and biochemical markers of bone turnover. A hundred and thirty-nine normal weight adult thalassemic patients (72 men and 67 women) were studied. Lumbar and femoral neck BMD were measured in 106/139 patients. Sixty-eight patients underwent growth hormone releasing hormone plus arginine testing. Measurement of baseline IGF-I and IGF-II was performed in all patients, while osteocalcin, C-terminal telopeptide of type I collagen (CTx), and urinary cross-linked N-telopeptides of type I collagen (NTx) were assayed in 95 of them. Femoral and lumbar osteoporosis/Z score below the expected range for age were documented in 61.3 and in 56.6 % of patients, respectively. Severe GH deficiency (GHD) was demonstrated in 27.9 % of cases, whereas IGF-I SDS was low in 86.3 %. No thalassemic patients displayed circulating levels of IGF-II below the reference range. GH peaks were positively correlated with femoral, but not lumbar, Z score. No correlations were found between GH peaks and osteocalcin, CTx and NTx. GH peaks were positively correlated with IGF-I values, which in their turn displayed a positive correlation with osteocalcin, CTx, and NTx. No correlations emerged between IGF-I values and either femoral or lumbar Z scores. No correlations were found between IGF-II and any of the following parameters: GH peaks, osteocalcin, CTx, NTx, femoral Z score, and lumbar Z score. Our study, besides providing for the first time evidence of a normal IGF-II production in thalassemia, contributes to a better understanding of the involvement of the somatotropin-somatomedin axis in the pathophysiology of bone demineralization in this disease. In particular, the contribution of GHD to femoral osteoporosis appears to be likely mediated by locally produced rather than circulating IGF-I.

KW - Growth hormone

KW - IGF-I

KW - IGF-II

KW - Thalassemia

UR - http://www.scopus.com/inward/record.url?scp=84955608076&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955608076&partnerID=8YFLogxK

U2 - 10.1007/s12020-016-0865-1

DO - 10.1007/s12020-016-0865-1

M3 - Article

VL - 53

SP - 551

EP - 557

JO - Endocrine

JF - Endocrine

SN - 1355-008X

IS - 2

ER -