Assessing bone turnover and the role of vitamin D deficiency in patients with myelofibrosis
Authors:
M. Palová 1; T. Szotkowski 1; A. Hluší 1; J. Navrátilová 1; M. Divoká 1; T. Papajík 1; P. Petrová 2; J. Prošková 2
Authors‘ workplace:
Hemato-onkologická klinika, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc
1; Oddělení klinické biochemie Fakultní nemocnice Olomouc
2
Category:
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Overview
Introduction: Primary myelofibrosis belongs to a group of Philadelphia chromosome-negative myeloproliferative neoplasms (Ph-MPN) together with essential thrombocythemia and polycythemia vera, which may also progress to bone marrow fibrosis. The study assessed biochemical markers of bone remodelling and osteoprotegerin to find a suitable marker for non-invasive monitoring of bone marrow fibrosis, as well as bone metabolism, in particular the role of vitamin D.
Patients and methods: Bone remodelling markers (bALP, P1NP, ICTP), bone metabolism and osteoprotegerin were analysed in 34 patients with myelofibrosis, 13 patients with pre-fibrotic primary myelofibrosis and a group of 28 patients with essential thrombocythemia and polycythemia vera.
Results: There was no increase in bALP. P1NP and ICTP were elevated in 18% and 32% of MF, respectively. The values neither correlated with fibrosis stage nor showed significant differences compared to the other Ph-MPN. Osteoprotegerin was increased in 53% of myelofibrosis, values correlated with myelofibrosis risk status (p=0.0043) but did not show a significant difference compared to the other Ph-MPN. Among bone metabolism parameters, significant differences were noted for vitamin D levels. Myelofibrosis had significantly lower vitamin D levels than the other Ph-MPN (p=0.0003), the values correlated with MF risk status (p=0.05).
Conclusion: The tested parameters are not sensitive enough for non-invasive monitoring of bone marrow fibrosis in routine clinical practice. Increased expression of osteoprotegerin is likely to play a role in the pathogenesis of myelofibrosis. Serum concentrations of vitamin D are significantly lower in myelofibrosis; the severity of deficiency correlates with disease stage. Given the fact that vitamin D participates in inhibition of the JAK/STAT signalling pathway, there is an urgent need to verify its prognostic value in the present-day era of JAK inhibitors.
KEY WORDS:
Ph-myeloproliferative neoplasms – myelofibrosis – bone turnover – osteoprotegerin – vitamin D
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