Discussion
fracture, hypogonadism, pain, fractures, vertebral fracture, thalassemia, beta-thalassemia, osteoporosis
HYPOGONADISM, OSTEOPOROSIS, ADVERSE EVENT, THALASSEMIA, BETA-THALASSEMIA, TAO
Currently, bisphosphonates are the mainstay of treatment of TAO, particularly the intravenous forms (Alendronate 10 mg once daily for 24 months has been shown to improve BMD only at femoral neck in 9 beta-thalassemia patients with hypogonadism who received hormone replacement therapy (HRT) (In addition to mean BMD improvement, fewer patients in the alendronate group had declined BMD at L1-L4 from their baseline (33.3% vs 50%). This suggests that although alendronate did not improve BMD in all patients, it helped slow the rate of BMD reduction. Since one-third of patients did not adequately respond to 12 months of alendronate, the longer treatment duration, switching to more potent anti-resorptive agents such as zoledronate (The efficacy of alendronate in the reduction of the risk of fracture has been shown regardless of the improvement in BMD among postmenopausal women (LSC was defined as the least significant change in bone marker level that results in clinical significance. It has been proposed that the LSC was approximately 25% for serum CTX and P1NP levels (The most commonly reported adverse event of alendronate is upper gastrointestinal tract side effects found in 41–47% among postmenopausal osteoporotic patients (Another important endpoint is back pain, which may affect patients’ quality of life. In previous studies, zoledronate significantly reduced bone pain in thalassemia with osteoporosis (Not all thalassemia patients with low BMD need pharmacological treatment. According to The ISCD 2013 Pediatric Official Positions (There were some limitations of this study. First, since the follow-up period is relatively short, it was unable to measure fracture rate as an important clinical outcome. Therefore, we also measured BTMs, which may correlate with fractures among patients receiving alendronate from the previous report. In addition, VFA after the study drug was also performed and no new vertebral fracture was found during the study period. Second, the number of patients in the study was relatively small. However, we recruited more than the expected sample size, and there was a low rate of incomplete follow-up (7.8%). Last, we did not collect the data on diet and physical activity of the participants which may affect the study outcomes. However, we prescribed calcium and vitamin D supplements to all participants to ensure the adequacy of these daily requirements while taking study drug.