Abstract | CONTEXT: OBJECTIVE: This study investigated risk factors for incident, severe, and persistent hypophosphatemia, and associated alterations in bone and mineral biomarkers following intravenous iron treatment. METHODS: RESULTS: FCM was the only consistent risk factor for incident hypophosphatemia (< 2.0 mg/dL; odds ratio vs FDI: 38.37; 95% CI: 16.62, 88.56; P < 0.001). Only FCM-treated patients developed severe hypophosphatemia (< 1.0 mg/dL; 11.3%; 13/115) or persistent hypophosphatemia (< 2.0 mg/dL at study end; 40.0%; 46/115). More severe hypophosphatemia associated with significantly greater increases in iFGF23, PTH, and alkaline phosphatase, and more severe decreases in 1,25( OH)2D and ionized calcium (all P < 0.05). Patients with persistent vs resolved hypophosphatemia demonstrated significantly greater changes in iFGF23, PTH, 1,25( OH)2D, and N-terminal procollagen-1 peptide levels (all P < 0.01), but alkaline phosphatase increased similarly in both groups. CONCLUSION: Treatment with FCM was the only consistent risk factor for hypophosphatemia. Patients who developed severe or persistent hypophosphatemia after FCM treatment manifested more severe derangements in bone and mineral metabolism. Changes in bone biomarkers continued beyond resolution of hypophosphatemia, suggesting ongoing effects on bone that may help explain the association of FCM with osteomalacia and fractures.
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Authors | Benedikt Schaefer, Heinz Zoller, Myles Wolf |
Journal | The Journal of clinical endocrinology and metabolism
(J Clin Endocrinol Metab)
Vol. 107
Issue 4
Pg. 1009-1019
(03 24 2022)
ISSN: 1945-7197 [Electronic] United States |
PMID | 34850000
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. |
Chemical References |
- Biomarkers
- Disaccharides
- Ferric Compounds
- Minerals
- Parathyroid Hormone
- ferric carboxymaltose
- Maltose
- ferric derisomaltose
- Iron
- Alkaline Phosphatase
- Calcium
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Topics |
- Alkaline Phosphatase
(therapeutic use)
- Anemia, Iron-Deficiency
(complications, drug therapy)
- Biomarkers
- Calcium
(therapeutic use)
- Disaccharides
- Familial Hypophosphatemic Rickets
(complications)
- Female
- Ferric Compounds
- Humans
- Hypophosphatemia
(chemically induced, epidemiology)
- Iron
- Male
- Maltose
(analogs & derivatives)
- Minerals
- Osteomalacia
- Parathyroid Hormone
(therapeutic use)
- Risk Factors
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