Iron deficiency affects one in four women of childbearing age in Europe. Modern intravenous iron preparations quickly remedy the deficiency, but an international observational study by the Medical University of Innsbruck warns of long-term consequences of a frequently used active ingredient: iron carboxymaltose is associated with a more than twice as high risk of bone fractures as the comparator preparation iron derisomaltose.

Iron deficiency is caused, among other things, by impaired absorption in intestinal diseases, increased demand during pregnancy or growth phases, and blood loss during heavy menstrual bleeding. Oral preparations often have a slow effect and are poorly tolerated, which is why infusions are increasingly used.

When iron carboxymaltose is administered, the phosphate level in the blood drops significantly in 50 to 75 percent of those treated. This can lead to muscle weakness and bone disease. Researchers led by Heinz Zoller from the Christian Doppler Laboratory for Iron and Phosphate Biology at the Medical University of Innsbruck have investigated the mechanism. The analyses show that iron carboxymaltose accumulates strongly in the bone, where it reduces collagen formation and inhibits new bone formation. The symptoms of a low phosphate level are similar to those of an iron deficiency and therefore often go unnoticed.

In a large-scale observational study with more than 20,000 patients, conducted together with partners from Kiel, Vienna and New York, among others, the increased risk was clinically confirmed. The results were published in the journal “Blood”. Bone fractures typically occur weeks or months after therapy.

The researchers conclude that iron carboxymaltose triggers molecular changes in the bone that can weaken the bone structure regardless of the phosphate level. The choice of iron supplement thus affects not only the speed of treatment, but also the long-term risk of “biological fatigue” of the bone.

The data underscore the need to take greater account of fracture risk in clinical practice. Further studies are to clarify the exact biological relationships in humans.

Original Paper:

Ferric Carboxymaltose Increases Fracture Risk in Patients and Reduces Bone Formation in Mice with Iron Deficiency Anemia | Blood | American Society of Hematology

Editor: X-Press Journalistenbüro GbR

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