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| Calcif Tissue Int. 2004 Nov 4; [Epub ahead of print] Related Articles, Links
Ascorbic Acid Deficiency, Iron Overload and Alcohol Abuse Underlie the Severe
Osteoporosis in Black African Patients with Hip Fractures - A Bone
Histomorphometric Study.
Schnitzler CM, Schnaid E, Macphail AP, Mesquita JM, Robson HJ.
MRC Mineral Metabolism Research Unit, university of the Witwatersrand,
Johannesburg, South Africa.
Osteoporosis and femoral neck fractures (FNF) are uncommon in black Africans
although osteoporosis accompanying iron overload (from traditional beer brewed
in iron containers) associated with ascorbic acid deficiency (oxidative
catabolism by iron) has been described from sub-Saharan Africa. This study
describes histomorphometric findings of iliac crest bone biopsies and serum
biochemical markers of iron overload and of alcohol abuse and ascorbic acid
levels in 50 black patients with FNFs (29 M, 21 F), age 62 years (40-95) years
(median [min-max]), and in age- and gender-matched black controls. We found
evidence of iron overload in 88% of patients and elevated markers of alcohol
abuse in 72%. Significant correlations between markers of iron overload and of
alcohol abuse reflect a close association between the two toxins. Patients had
higher levels of iron markers, i.e., siderin deposits in bone marrow ( P <
0.0001), chemical non-heme bone iron ( P = 0.012), and serum ferritin ( P =
0.017) than controls did. Leukocyte ascorbic acid levels were lower ( P =
0.0008) than in controls. The alcohol marker mean red blood cell volume was
elevated ( P = 0.002) but not liver enzymes or uric acid. Bone volume,
trabecular thickness, and trabecular number were lower, and trabecular
separation was greater in patients than in controls, all at P < 0.0005; volume,
surface, and thickness of osteoid were lower and eroded surface was greater,
all at P < 0.0001. There was no osteomalacia. Ascorbic acid deficiency
accounted significantly for decrease in bone volume and trabecular number, and
increase in trabecular separation, osteoid surface, and eroded surface; iron
overload accounted for a reduction in mineral apposition rate. Alcohol markers
correlated negatively with osteoblast surface and positively with eroded
surface. Relative to reported data in white FNF patients, the osteoporosis was
more severe, showed lower osteoid variables and greater eroded surface; FNFs
occurred 12 years earlier and were more common among men. We conclude that the
osteoporosis underlying FNFs in black Africans is severe, with marked
uncoupling of resorption and formation in favor of resorption. All three
factors-ascorbic acid deficiency, iron overload, and alcohol abuse-contributed
to the osteoporosis, in that order.
PMID: 15549637 [PubMed - as supplied by publisher]
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