Assessment of Biochemical Markers of Bone Turnover and their Association in Iraqi Thalassemia Patients

Background: Thalassemia syndromes are heterogeneous groups of inherited anemia. Managing these conditions often requires regular blood transfusions, which can lead to complications, such as iron overload and bone disorders. This study aimed to examine the biochemical markers of bone turnover in thalassemia patients and investigate their associations in the Iraqi cohort. Method: The study involved 45 thalassemia patients and 45 healthy control subjects. Fibroblast growth factor 23 (FGF-23), phosphorus, vitamin D, vitamin K, matrix Gla protein (MGP), and parathyroid hormone (PTH) were measured by ELISA kit, and the level of calcium ion was determined by atomic absorption spectrometry technique. Results: The results demonstrated that the levels of FGF-23 and phosphorus were considerably higher in patients with thalassemia than in control (p=0.0001**). Conversely, the levels of vitamin D (p=0.005**), vitamin K (p=0.0002**), MGP (p=0.0003**), and PTH (p=0.0001**) were significantly lower in thalassemia patients compared to control subjects. Furthermore, no significant difference in calcium levels between the two groups (p-value = 0.465) was observed. The association of bone biochemical markers demonstrated that FGF-23 has a positive significant correlation with phosphorous and is inversely correlated with vitamin D, PTH, vitamin K, and MGP. Moreover, PTH has a positive significant correlation with vitamin D, vitamin K, and MGP. However, it has a significant negative correlation with PTH and phosphorous. Conclusion: These findings show that patients with thalassemia display biochemical markers associated with bone and cardiovascular disorders, indicating the need for specialized medical treatments for this patient population.