Iron overload, characterized by elevated serum ferritin levels, has long been associated with various systemic complications, yet its impact on skeletal health has not been as well understood. A recent large population-based study with results published in the Journal of Clinical Endocrinology and Metabolism sheds light on this critical issue by identifying a significant association between iron overload and an increased risk of major osteoporotic fractures.
The elevated fracture risk is predominantly driven by laboratory-ascertained iron overload, as indicated by serum ferritin levels above 1000 μg/L. In contrast, patients diagnosed with iron overloading disorders but without elevated ferritin levels did not show a similarly increased risk. This distinction underscores the critical role of ferritin as a biomarker for identifying patients at heightened risk. Within the cohort of patients with iron overload, those with serum ferritin levels exceeding 1000 μg/L had a 57% increased risk of fracture compared to individuals with a diagnosis of an iron overloading disorder but without elevated serum ferritin.
“The main clinical message from our findings is that clinicians should consider iron overloading as a risk factor for fracture. Importantly, among high-risk patients presenting with serum ferritin values exceeding 1000 μg/L, osteoporosis screening and treatment strategies should be initiated in accordance with the guidelines for patients with hepatic disease,” the authors wrote. This statement emphasizes the practical implications of the study, urging healthcare providers to integrate fracture risk assessment into the management of iron overload, particularly for patients with markedly elevated ferritin levels. By doing so, clinicians can proactively address skeletal fragility and potentially mitigate the burden of fractures in this high-risk population.
Prior research on a smaller scale demonstrated a sixfold higher prevalence of osteoporosis in patients with hereditary hemochromatosis, with fracture risks increasing threefold in patients with ferritin levels above 1000 μg/L. Such studies have highlighted a close association between bone fragility, disease duration, and the extent of iron overload. The present study builds on this evidence by providing a larger, population-based perspective that strengthens the case for ferritin level monitoring as a critical component of fracture risk assessment.
In conclusion, this study provides compelling evidence that iron overload, particularly when serum ferritin levels exceed 1000 μg/L, significantly increases the risk of osteoporotic fractures. These findings reinforce the importance of incorporating fracture risk assessment and osteoporosis screening into the clinical management of patients with high iron overload.
Sources: Journal of Clinical Endocrinology and Metabolism, Medscape
