Yıl: 2020 Cilt: 18 Sayı: 2 Sayfa Aralığı: 66 - 72 Metin Dili: İngilizce DOI: 10.21911/aai.501 İndeks Tarihi: 05-06-2021

Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study

Öz:
Objective: Common variable immunodeficiency (CVID) is a relatively frequent primary immunodeficiency disorder characterized byimpaired B cell differentiation with hypogammaglobulinemia in the European Society for Immunodeficiencies (ESID) registry system.Increased inflammatory cytokines, prolonged and/or recurrent infections, gastrointestinal complications, and anti-inflammatorymedications are risk factors for diminished bone mineral density (BMD) in CVID patients.Materials and Methods: The study group included 32 patients with CVID (19 males and 13 females; mean age: 37.33 ± 13.70 years,40.6% female), who had been followed up on a regular basis for a period of four years. The patients were categorized into two groupsaccording to their BMD: low BMD and normal BMD.Results: Seventeen patients (8 females and 9 males) had normal BMD (mean age 34.94 ± 11.41 years, 47.1% female) and fifteen patients(5 females and 10 males) had low BMD (mean age 40.03 ± 15.87 years, 33.3% female). In the low BMD group, three patients hadosteoporosis and 12 patients had osteopenia. Univariate regression analysis revealed that lymphopenia (odds ratio, OR:6.562, 95%confidence interval, CI: 1.095-39.324, p=0.039) was significantly associated with low BMD. Multivariate regression analysis showed thathigher alkaline phosphatase (ALP) levels (OR:1.017, 95% CI 1.001-1.033, p=0.041), lymphopenia (OR:11.028, 95% CI 1.326-91.709,p=0.026), and lower folic acid levels (OR:1.284, 95% CI 1.007-1.637, p=0.043) were also independent predictors for low BMD.Conclusion: Even with some limitations such as the small number for the study population, a single center experience, and a crosssectional design, we recommend that clinical immunologists should be alert for diminished BMD in CVID patients, especially thosewith low folic acid and high ALP levels and lymphopenia.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Gathmann B, Mahlaoui N, Gerard L, Oksenhendler E, Warnatz K, Schulze I, et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol 2014;134(1):116-26.
  • 2. Verma N, Grimbacher B, Hurst JR. Lung disease in primary antibody deficiency. Lancet Respir Med 2015;3(8):651-60.
  • 3. Azizi G, Abolhassani H, Kiaee F, Tavakolinia N, Rafiemanesh H, Yazdani R, et al. Autoimmunity and its association with regulatory T cells and B cell subsets in patients with common variable immunodeficiency. Allergol Immunopathol (Madr) 2018;46(2):127-35.
  • 4. Tak Manesh A, Azizi G, Heydari A, Kiaee F, Shaghaghi M, Hossein-Khannazer N, et al. Epidemiology and pathophysiology of malignancy in common variable immunodeficiency? Allergol Immunopathol (Madr) 2017;45(6):602-15.
  • 5. Uzzan M, Ko HM, Mehandru S, Cunningham-Rundles C. Gastrointestinal disorders associated with common variable immune deficiency (CVID) and chronic granulomatous disease (CGD). Curr Gastroenterol Rep 2016;18(4):17.
  • 6. Maglione PJ. Autoimmune and lymphoproliferative complications of common variable immunodeficiency. Curr Allergy Asthma Rep 2016;16(3):19.
  • 7. Ballow M. Managing comorbid complications in patients with common variable immunodeficiency. Ann Allergy Asthma Immunol 2013;111(Suppl 6):S6-9.
  • 8. Briot K, Geusens P, Em Bultink I, Lems WF, Roux C. Inflammatory diseases and bone fragility. Osteoporos Int 2017;28(12):3301-14.
  • 9. Tanaka Y, Nakayamada S, Okada Y. Osteoblasts and osteoclasts in bone remodeling and inflammation. Curr Drug Targets Inflamm Allergy 2005;4(3):325-8.
  • 10. D’Amelio P, Sassi F. Gut Microbiota, Immune System, and Bone. Calcif Tissue Int 2018;102(4):415-25.
  • 11. Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (PanAmerican Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clin Immunol 1999;93(3):190- 7.
  • 12. Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many women have osteoporosis? J Bone Miner Res 1992;7(9):1005-10.
  • 13. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N. A reference standard for the description of osteoporosis. Bone 2008;42(3):467-75.
  • 14. Bellelli V, d’Ettorre G, Celani L, Borrazzo C, Ceccarelli G, Venditti M. Clinical significance of lymphocytopenia in patients hospitalized with pneumonia caused by influenza virus. Crit Care 2019;23(1):330.
  • 15. Zhou F, Li H, Gu L, Liu M, Xue CX, Cao B, et al. Risk factors for nosocomial infection among hospitalised severe influenza A(H1N1)pdm09 patients. Respir Med 2018;134:86-91.
  • 16. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: Clinical and immunological features of 248 patients. Clin Immunol 1999;92(1):34-48.
  • 17. Fevang B, Yndestad A, Sandberg WJ, Holm AM, Muller F, Aukrust P, et al. Low numbers of regulatory T cells in common variable immunodeficiency: Association with chronic inflammation in vivo. Clin Exp Immunol 2007;147(3):521-5.
  • 18. Serana F, Airo P, Chiarini M, Zanotti C, Scarsi M, Frassi M, et al. Thymic and bone marrow output in patients with common variable immunodeficiency. J Clin Immunol 2011;31(4):540-9.
  • 19. Adami G, Fassio A, Rossini M, Caimmi C, Giollo A, Orsolini G, et al. Osteoporosis in Rheumatic Diseases. Int J Mol Sci. 2019;20(23).
  • 20. Malphettes M, Gerard L, Carmagnat M, Mouillot G, Vince N, Boutboul D, et al. Late-onset combined immune deficiency: A subset of common variable immunodeficiency with severe T cell defect. Clin Infect Dis 2009;49(9):1329-38.
  • 21. Eastell R, Hannon RA. Biomarkers of bone health and osteoporosis risk. Proc Nutr Soc 2008;67(2):157-62.
  • 22. Mukaiyama K, Kamimura M, Uchiyama S, Ikegami S, Nakamura Y, Kato H. Elevation of serum alkaline phosphatase (ALP) level in postmenopausal women is caused by high bone turnover. Aging Clin Exp Res 2015;27(4):413-8.
  • 23. Ivaska KK, Lenora J, Gerdhem P, Akesson K, Vaananen HK, Obrant KJ. Serial assessment of serum bone metabolism markers identifies women with the highest rate of bone loss and osteoporosis risk. J Clin Endocrinol Metab 2008;93(7):2622-32.
  • 24. Garnero P, Sornay-Rendu E, Claustrat B, Delmas PD. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: The OFELY study. J Bone Miner Res 2000;15(8):1526-36.
  • 25. Delmas PD, Licata AA, Reginster JY, Crans GG, Chen P, Misurski DA, et al. Fracture risk reduction during treatment with teriparatide is independent of pretreatment bone turnover. Bone 2006;39(2):237-43.
  • 26. Sarkar M, Bhardwaj R, Madabhavi I, Khatana J. Osteoporosis in chronic obstructive pulmonary disease. Clin Med Insights Circ Respir Pulm Med 2015;9:5-21.
  • 27. Aytekin G, Cölkesen F, Yıldız E, Arslan S. Risk factors of bronchiectasis in adult patients with common variable immunodeficiency. Asthma Allergy Immunol 2019;17:160-5.
  • 28. Gregg EW, Cauley JA, Seeley DG, Ensrud KE, Bauer DC. Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1998;129(2):81-8.
  • 29. Fratoni V, Brandi ML. B vitamins, homocysteine and bone health. Nutrients 2015;7(4):2176-92.
  • 30. Mohebbi A, Azizi G, Tavakolinia N, Abbasi F, Sayarifard F, Karimipour M, et al. Comparison of bone mineral density in common variable immunodeficiency and X-linked agammaglobulinaemia patients. Endocr Metab Immune Disord Drug Targets 2017;17(2):134-40.
  • 31. Baris S, Ozen A, Ercan H, Karakoc-Aydiner E, Cagan H, Ozdemir C, et al. Osteoporosis: An ignored complication of CVID. Pediatr Allergy Immunol 2011;22(7):676-83.
  • 32. Swart KM, van Schoor NM, Lips P. Vitamin B12, folic acid, and bone. Curr Osteoporos Rep 2013;11(3):213-8.
  • 33. Almassinokiani F, Kashanian M, Akbari P, Mossayebi E, Sadeghian E. Folic acid supplementation reduces plasma homocysteine in postmenopausal women. J Obstet Gynaecol 2016;36(4):492-5.
  • 34. Salari P, Abdollahi M, Heshmat R, Meybodi HA, Razi F. Effect of folic acid on bone metabolism: A randomized double blind clinical trial in postmenopausal osteoporotic women. Daru 2014;22:62.
  • 35. Cagnacci A, Bagni B, Zini A, Cannoletta M, Generali M, Volpe A. Relation of folates, vitamin B12 and homocysteine to vertebral bone mineral density change in postmenopausal women. A fiveyear longitudinal evaluation. Bone 2008;42(2):314-20.
APA Aytekin G, ÇÖLKESEN F, YILDIZ E, Arslan S, CALISKANER A (2020). Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. , 66 - 72. 10.21911/aai.501
Chicago Aytekin Gökhan,ÇÖLKESEN FATİH,YILDIZ ERAY,Arslan Sevket,CALISKANER Ahmet Zafer Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. (2020): 66 - 72. 10.21911/aai.501
MLA Aytekin Gökhan,ÇÖLKESEN FATİH,YILDIZ ERAY,Arslan Sevket,CALISKANER Ahmet Zafer Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. , 2020, ss.66 - 72. 10.21911/aai.501
AMA Aytekin G,ÇÖLKESEN F,YILDIZ E,Arslan S,CALISKANER A Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. . 2020; 66 - 72. 10.21911/aai.501
Vancouver Aytekin G,ÇÖLKESEN F,YILDIZ E,Arslan S,CALISKANER A Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. . 2020; 66 - 72. 10.21911/aai.501
IEEE Aytekin G,ÇÖLKESEN F,YILDIZ E,Arslan S,CALISKANER A "Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study." , ss.66 - 72, 2020. 10.21911/aai.501
ISNAD Aytekin, Gökhan vd. "Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study". (2020), 66-72. https://doi.org/10.21911/aai.501
APA Aytekin G, ÇÖLKESEN F, YILDIZ E, Arslan S, CALISKANER A (2020). Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. Astım Allerji İmmünoloji, 18(2), 66 - 72. 10.21911/aai.501
Chicago Aytekin Gökhan,ÇÖLKESEN FATİH,YILDIZ ERAY,Arslan Sevket,CALISKANER Ahmet Zafer Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. Astım Allerji İmmünoloji 18, no.2 (2020): 66 - 72. 10.21911/aai.501
MLA Aytekin Gökhan,ÇÖLKESEN FATİH,YILDIZ ERAY,Arslan Sevket,CALISKANER Ahmet Zafer Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. Astım Allerji İmmünoloji, vol.18, no.2, 2020, ss.66 - 72. 10.21911/aai.501
AMA Aytekin G,ÇÖLKESEN F,YILDIZ E,Arslan S,CALISKANER A Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. Astım Allerji İmmünoloji. 2020; 18(2): 66 - 72. 10.21911/aai.501
Vancouver Aytekin G,ÇÖLKESEN F,YILDIZ E,Arslan S,CALISKANER A Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study. Astım Allerji İmmünoloji. 2020; 18(2): 66 - 72. 10.21911/aai.501
IEEE Aytekin G,ÇÖLKESEN F,YILDIZ E,Arslan S,CALISKANER A "Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study." Astım Allerji İmmünoloji, 18, ss.66 - 72, 2020. 10.21911/aai.501
ISNAD Aytekin, Gökhan vd. "Bone Metabolism Alterations in Patients with Common Variable Immune Deficiency: A Retrospective Cohort Study". Astım Allerji İmmünoloji 18/2 (2020), 66-72. https://doi.org/10.21911/aai.501