The clinical utility of bone turnover markers in the evaluation of bone disease in patients with haemophilia A and B

• DOI: 10.1111/hae.12271
• Publication Date: 2013-10-12T02:03:34Z
• Authors: P. Anagnostis; S. Vakalopoulou; T.‐A. Vyzantiadis; M. Charizopoulou; S. Karras; D. G. Goulis; A. Karagiannis; S. Gerou; V. Garipidou
• Keywords: Adult; Male; Middle Aged; Hemophilia A; Hemophilia B; Collagen Type I; 3. Good health; Fractures, Bone; 03 medical and health sciences; 0302 clinical medicine; Bone Density; Risk Factors; Humans; Prospective Studies; Bone Diseases; Joint Diseases; Biomarkers; Aged

SummaryHaemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, the utility of bone turnover markers (BTM) remains unknown. The aim of this study was to evaluate bone metabolism in men with haemophilia and to investigate associations betweenBTMand bone disease. Serum N‐ (NTX‐I), C‐terminal telopeptide of type I collagen (CTX‐I) and tartrate‐resistant acid phosphatase band‐5b (TRAP‐5b), as bone resorption markers, and osteocalcin (OC) and bone‐specific alkaline phosphatase (b‐ALP), as bone formation markers, were assessed. Seventy men with haemophilia A (n = 59) or B (n = 11) were studied. Patients with lowBMDhad significantly higher b‐ALPconcentrations compared with those with normalBMD(12.8 ± 1.60 vs. 9.72 ± 0.58 μg/L,P = 0.009), without any differences in the otherBTM.NTX‐I andCTX‐I concentrations were negatively associated with oestradiol levels and hipBMDand positively with human immunodeficiency virus infection, number of affected joints and arthropathy scores. B‐ALPandOCconcentrations were negatively associated with hipBMD, severity of haemophilia and fracture history, and positively with the number of affected joints and testosterone concentrations. After multivariate analysis,NTX‐I levels remained negatively associated with oestradiol levels, whereas b‐ALPconcentrations negatively correlated with the level of physical activity and positively with the number of affected joints. Increased bone metabolism exists in men with haemophilia and lowBMD. Increased b‐ALPlevels may identify patients at high risk for fracture. Increased number of target joints, low physical activity and low oestradiol concentrations are independently associated with increased bone metabolism.