Role of hypogonadism in development of bone alterations in thalassemic patients: HRT effects on bone mass deficiency

Because this important role of hypogonadism, we should expect that hormonal replacement therapy (HRT) corrects or prevents bone mass deficiency in adult TM patients. Conflicting results have been presented with some studies indicating a clear improvement and other giving doubtful results. In our recent study, we found that female TM patients treated with HRT still have reduced bone mass and increased bone turnover compared to normal women of similar age. However, patients who started the HRT in younger age had better results than patients who started the treatment later. Maybe, it is important to start the treatment early, at the pubertal age. On the other hand, it cannot be excluded that HRT is not sufficient because other factors contribute to the bone mass deficiency of TM patients. Consistent with our results, Lasco et al. found that bone mass, measured by DEXA, was lower in all TM patients than in controls, but the difference was more marked in patients who didn't receive HRT. We can conclude that HRT is an important 
part of the treatment of bone mass deficiency in adult TM patients but that the treatment has to be started early and that often alone is not sufficient to normalize bone mass. Because of the disappointing results of HRT on bone mass in adult TM patients, it has been suggested to associate HRT and bisphosphonates. Limited experience is available but the results of our group and of other authors suggest that the results may be better than with HRT alone.

Conclusions

Hypogonadism is very common in adult TM patients and may be present in about 80% of the patients. It is important to assess hypothalamic-pituitary-gonadal function in young women with beta thalassemia major, so that those with gonadal failure may start as soon as possible the replacement therapy. Patients with normal gonadal function should re-evaluate periodically their sexual hormone function because hypogonadism may develop after puberty and involve both pituitary and the gonads. In patients who do not respond adequately to HRT, other possible causes of osteoporosis should be screened and bisphosphonates could be added to the substitution therapy. Beat the drug companies and buy cialis 200mg online