The association of growth differentiation factor-15 levels and osteoporosis in patients with thalassemia

Introduction: Ineffective erythropoiesis is a significant risk factor for osteoporosis in individuals with thalassemia. Growth differentiation factor-15 (GDF15), a biomarker of ineffective erythropoiesis, has previously been found to be elevated in thalassemia patients. The purpose of this study was to examine the association between GDF15 levels and osteoporosis in patients with thalassemia. Methods: : A cross-sectional study was conducted in 130 adult patients with thalassemia at Srinagarind Hospital, Thailand. Bone mineral density (BMD) at the lumbar spine was evaluated by dual-energy X-ray absorptiometry (DXA), and with a Z-score of less than -2.0 SD was defined as osteoporosis. GDF-15 was measured using the enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was used to examine the associated factors with the development of osteoporosis. Receiver operator characteristic (ROC) curve analysis was used to estimate the threshold of GDF15 in predicting osteoporosis. Results: : Osteoporosis was detected in 55.4% (72/130) of the patients. Advanced age and high GDF15 levels were positively associated with osteoporosis, while an increased hemoglobin level was negatively associated with osteoporosis in patients with thalassemia. In this study, the GDF15 level’s ROC demonstrated a good performance in predicting osteoporosis (AUC=0.77). Using a cut-off point of GDF15 ≥ 20,000 pg/mL, the sensitivity and specificity were 90.2% and 60.3%. Conclusions: : The prevalence of osteoporosis is high among adult thalassemia patients. Age and high GDF15 levels were significantly associated with osteoporosis in this study. A higher hemoglobin level is associated with a lower risk of osteoporosis. The findings of this study suggest that GDF15 could be used as a predictive biomarker for osteoporosis in patients with thalassemia. Adequate red blood cell transfusions and suppression of GDF15 function may be beneficial in preventing or delaying osteoporosis progression.