Assessing bone turnover and the role of vitamin D deficiency in patients with myelofibrosis

Czech version

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
Published in: Transfuze Hematol. dnes,25, 2019, No. 2, p. 159-167.
Category: Original Papers

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 remodeling 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 remodeling markers (bALP, P1NP, ICTP), bone metabolism and osteoprotegerin were analyzed in 34 patients with myelofibrosis, 13 patients with prefibrotic 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 its deficiency correlates with disease stage. Given the fact that vitamin D participates in inhibition of the JAK/STAT signaling pathway, there is an urgent need to verify its prognostic value in the present-day era of JAK inhibitors.

Keywords:

Ph-myeloproliferative neoplasms – myelofibrosis – bone turnover – osteoprotegerin

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