铁是一种重要的微量元素,在铁过载和缺铁的情况下对骨骼产生相反的作用。值得注意的是,在特殊情况下,缺铁患者通过静脉输注补充铁也会对骨骼产生不利影响。这些影响及其表现形式的不同机制导致了这种关系的复杂性。铁过载影响骨吸收和形成,加速骨吸收,同时减少骨形成。这些影响主要来自活性氧(ROS)的直接作用,影响扩散,分化,破骨细胞和成骨细胞的活性不同。这种失衡有利于破骨细胞并抑制成骨细胞。同时,多种途径,包括骨形态发生蛋白,RANK配体,和其他人,有助于这些行动,导致骨量减少和骨折易感性增加。相比之下,铁缺乏导致能量和辅因子缺乏导致骨转换低,两者都需要铁。贫血增加男性和女性骨折的风险。这种效应发生在不同的层面,降低肌肉性能,在骨骼特异性水平上,降低骨密度。至关重要的是,贫血增加了磷酸性激素iFGF23的合成,随后在生理条件下通过裂解使其失活。因此,iFGF23水平和磷酸盐排泄没有增加。然而,在特定情况下,贫血必须通过静脉铁治疗来管理,铁输注的成分-特别是麦芽糖-抑制iFGF23的裂解。因此,患者可能会出现严重的磷酸盐消耗,因此,低血磷性骨软化症。这种情况在临床实践中经常被忽视,并且通常由羧基麦芽糖铁引起。结束铁输注或更换药剂,以及磷酸盐和维生素D的补充,可以有效地解决这个问题。
Iron is a vital trace element and exerts opposing effects on
bone in both iron overload and iron deficiency situations. Remarkably, iron supplementation through intravenous infusion in patients with iron deficiency can also have detrimental effects on
bone in special cases. The diverse mechanisms underlying these effects and their manifestations contribute to the complexity of this relationship. Iron overload impacts both
bone resorption and formation, accelerating
bone resorption while reducing
bone formation. These effects primarily result from the direct action of reactive oxygen species (ROS), which influence the proliferation, differentiation, and activity of both osteoclasts and osteoblasts differently. This imbalance favors osteoclasts and inhibits the osteoblasts. Simultaneously, multiple pathways, including bone morphogenic proteins, RANK ligand, and others, contribute to these actions, leading to a reduction in bone mass and an increased susceptibility to fractures. In contrast, iron deficiency induces low bone turnover due to energy and co-factor deficiency, both of which require iron. Anemia increases the risk of fractures in both men and women. This effect occurs at various levels, reducing muscular performance and, on the bone-specific level, decreasing
bone mineral density. Crucially, anemia increases the synthesis of the phosphaturic hormone iFGF23, which is subsequently inactivated by cleavage under physiological conditions. Thus, iFGF23 levels and phosphate excretion are not increased. However, in specific cases where anemia has to be managed with intravenous iron treatment, constituents-particularly maltoses-of the iron infusion suppress the cleavage of iFGF23. As a result, patients can experience severe phosphate wasting and, consequently, hypophosphatemic osteomalacia. This condition is often overlooked in clinical practice and is often caused by ferric carboxymaltose. Ending iron infusions or changing the agent, along with phosphate and vitamin D supplementation, can be effective in addressing this issue.