Common Link between Bone and Heart Health in Thalassemia Major

Background. A common link between bone and heart health has been detected in the general population. In the present study we evaluated the relationship between bone mineral density (BMD) and cardiac iron, cardiovascular complications, and cardiovascular risk factors in patients with thalassemia major (TM).

Methods. We considered 135 TM patients (68 M, mean age 37.79±7.74 years) enrolled in the MIOT (Myocardial Iron Overload in Thalassemia) Network. BMDs of the lumbar vertebrae (L1-L4) and femoral neck were measured by dual X-ray absorptiometry (DEXA) and were expressed as T-scores. Myocardial iron overload (MIO) was quantified by the T2* Magnetic Resonance Imaging (MRI) technique. Blood samples were drawn for the analysis of N-terminal pro-brain natriuretic peptide (NT-proBNP), the gold standard biomarker in determining the diagnosis and prognosis of heart failure.

Results. MIO (global heart t2*<20 ms) was detected in 20 (14.8%) patients. Patients with MIO showed significant lower femoral T-scores (-2.64±1.87 vs -1.96±0.99; P=0.045).

Twelve patients showed cardiac complications (8 arrhythmias, 2 heart failure, 2 pulmonary hyperthension) and all of them had lumbar and femoral T-scores indicating osteopathy (osteopenia/osteoporosis). Patients with cardiac complications showed significant lower lumbar T-scores (-3.27±0.89 vs -2.43±1.29; P=0.031) and femoral T-scores (-2.96±2.02 vs -1.98±1.04; P=0.042).

Patients with abnormal NTproBNP values (>157 ng/L) showed significantly lower femoral T-scores (-2.41±0.61 vs -1.79±1.16; P=0.048).

Patients with diabetes (N=17) showed significant lower femoral T-scores (-2.45±0.79 vs -2.00±1.25; P=0.041).

Conclusion. Lower femoral BMD was associated with MIO, cardiac complications, elevated NTproBNP values, and diabetes in patients with thalassemia major. So, our data support and interaction between bone and cardiovascular diseases in TM, suggesting that prevention and treatment strategies targeted for one of the two diseases may be beneficial for the other one.