The risk of osteoporotic fractures is increased by 60% in patients with iron overload, according to a study from the UK presented at the 2022 Annual Meeting of the American Society of Bone and Mineral Research (ASBMR), Medscape reports.¹ They were also twice more likely to suffer a vertebral fracture. The risk was higher in men than in women.

This study included 21,166 patients, mean age 59 years, who had a serum ferritin level above 1000 µg/L or had been diagnosed with hemochromatosis or non-anemic thalassemia from 2010 through 2020. Men comprised nearly 60% of the study population. Data was sourced from the IQVIA Medical Research Database. A total of 198,037 on age, sex, year, and general practitioner-matched control patients were also included with up to 10 controls for each patient.

Results showed that the overall risk of osteoporotic fracture was 60% higher among patients in the iron overload group with adjusted hazard ratio (aHR) of 1.60. Over the course of the 10-year follow-up, 777 fractures (9.61 fractures per 1000 patient-years) in the patients with iron overload were recorded, while in the control group, there were 4344 fractures (4.68 fractures per 1000 patient-years).

When the incidence of osteoporosis was compared based on gender, there were 12.63 osteoporotic fractures per 1000 patient-years in the iron overload group vs 7.09 per 1000 patient-years in the control group among women. The osteoporotic fracture rate was 6.71 per 1000 patient-years in men in the iron overload group compared to 3.01 per 1000 patient-years in the control group.

The risk of osteoporotic fracture was increased by 48% among women with iron overload with aHR of 1.48, while men with iron overload faced an 82% higher risk of fractures with aHR of 1.82 compared to those who did not have iron overload.

Patients with iron overload were more likely to suffer a vertebral fracture or fracture of hip or humerus with aHR of 2.18, 1.60 and 1.82, respectively. However, no such risk was observed for fracture of the forearm bones.

Excess of iron damages the liver, the most common complication of iron overload. However, this large population study suggests the need to also regularly monitor bone mineral density (BMD) in patients with iron overload, particularly those with thalassemia who receive frequent blood transfusions or patients with hereditary hemochromatosis, for timely initiation of prophylactic measures to reduce the risk of fractures.

Osteoporosis is often a silent disease and causes fractures in the hip, spine and ribs later in life even with minimal trauma. It is not typically a disease exclusive to women. Men too are at risk.

Today is World Osteoporosis Day and the theme for this year is “Step Up for Bone Health”. Do regular exercise such as walking; eat a healthy balanced diet rich in calcium and vitamin D to prevent or slow down osteoporosis.

Reference

1. High iron levels predict greater fracture risk, more so in men - Medscape - Sep 21, 2022.