Role of hypogonadism in development of bone alterations in thalassemic patients

Although transfusions and chelation therapy have improved survival of patients afflicted with Thalassemia Major (TM), endocrine alterations are still common complications. Particularly, hypogonadism plays an important role in the aetiology of osteoporosis in these patients. It is clear that in most patients the gonadal failure is a consequence of a pituitary damage and that a hypogonadotropic hypogonadism occurs; nevertheless, also a gonadal damage because of iron deposition may be a further cause of hypogonadism. Prevalence of the pubertal failure ranges between 50 to 80% of the cases. In some studies ferritin levels have been correlated with hypogonadism, suggesting that improvement of chelation treatments may prevent or reduce the appearance of hypogonadism in TM patients. Treatment with HRT has shown conflicting results, but patients who started the treatment in young age present better results than those who started later. However we may conclude that HRT is an important treatment option but should be prescribed in early age and associated with biphosphonate