Procollagen I N-Terminal pro-peptide as a marker of bone remodeling in beta thalassemia pediatric patients: a case–control study

Osteoporosis is a significant cause of morbidity among beta-thalassemic patients. The amino-terminal pro-peptide of type I procollagen (P1NP) is considered the most sensitive biochemical turnover marker in patients with bone disease. The aim of the study was to assess the level of P1NP and bone mineral density (BMD) as measured by dual X-ray absorptiometry (DEXA) in β-thalassemic pediatric patients for early detection of signs of bone remodeling and assess their correlation to the efficacy of therapeutic interventions. Methods: Sixty patients with thalassemia major (TM) and intermedia (TI) were compared with 30 age- and sex-matched healthy controls. Assessment included serum P1NP, complete blood count, calcium, phosphorus, alkaline phosphatase, ferritin, and DEXA of the lumbar spine and femoral neck. Data were collected, revised, coded, and entered to the Statistical Package for the Social Sciences (IBM SPSS), version 24, and suitable tests were used. Results: P1NP was significantly higher among TM and TI compared with control and higher among TM versus TI ( P <0.05). Moreover, it was found to be significantly higher among female TM patients compared with males (10.5 ± 4.2 vs. 7 ± 2.3, P <0.05). Z-score and BMD (L1–L4, Neck of Lt. femur and total Lt. femur) were significantly lower among TM group compared with control and TI ( P <0.001). P1NP and DEXA did not correlate with the last serum ferritin level, hemoglobin level, or type of chelation therapy. In conclusion, thalassemia pediatric patients have higher P1NP and lower BMD at lumbar spine and femur, higher in TM than TI, and not correlated to hemoglobin level or chelation therapy type.