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van Erven B, Welling L, van Calcar SC, Doulgeraki A, Eyskens F, Gribben J, Treacy EP, Vos R, Waisbren SE, Rubio-Gozalbo ME, Bosch AM. Bone Health in Classic Galactosemia: Systematic Review and Meta-Analysis. JIMD Rep 2016; 35:87-96. [PMID: 27995581 DOI: 10.1007/8904_2016_28] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/24/2016] [Accepted: 11/16/2016] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Previous studies have reported an association between classic galactosemia (CG) and decreased bone mass. The primary objective of this systematic review with meta-analysis was to determine the extent of bone mineral density (BMD) Z-score reduction. Low BMD was defined as a Z-score ≤-2 standard deviations (SD). The secondary objective was to evaluate other indicators of bone status through a descriptive analysis. METHODS Systematic search strategies were developed by an experienced clinical librarian. Selection of relevant manuscripts, risk of bias assessment, and data extraction were performed independently by two investigators. RESULTS Four studies were included in the meta-analysis. BMD Z-scores in children and adults with CG measured at the lumbar spine (LBMD; 4 studies; n = 112), total hip (HBMD; 2 studies; n = 58), and femoral neck (FBMD; 2 studies; n = 73) were assessed. Mean BMD Z-scores in the CG population were LBMD -0.70 (95% CI: -0.88, -0.52); HBMD -0.89 (95% CI: -1.14, -0.64); and FBMD -0.63 (95% CI -1.29, 0.02). Results from studies included in the descriptive analysis (n = 7) show that vitamin D levels were frequently in the low reference range, whereas serum calcium levels were within reference range. CONCLUSION The mean BMD Z-score in the CG population is -0.7, which is lower than in the general population, though still within two SD of the reference mean of zero. This indicates that bone health is mildly affected in CG and that more patients, compared to the general population, are at risk for a BMD Z-score ≤-2 SD. In conclusion, clinicians should ensure appropriate preventive and therapeutic measures for CG patients.
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Affiliation(s)
- Britt van Erven
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Center, PO Box 5800, 6202, Maastricht, The Netherlands
| | - Lindsey Welling
- Department of Pediatrics, Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandra C van Calcar
- Department of Molecular and Medical Genetics, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Artemis Doulgeraki
- Department of Bone and Mineral Metabolism, Institute of Child Health, Agia Sophia Children's Hospital, Athens, Greece
| | - François Eyskens
- Department of Metabolic Disorders in Children, Antwerp University Hospital UZA, Edegem, Belgium.,Center of Inherited Metabolic Diseases, Metabolic Lab PCMA, Wilrijk, Belgium
| | - Joanna Gribben
- Nutrition & Dietetics Department, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Eileen P Treacy
- Mater Misericordiae University Hospital, Trinity College Dublin, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - Rein Vos
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Susan E Waisbren
- Division of Genetics and Genomics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Center, PO Box 5800, 6202, Maastricht, The Netherlands.
| | - Annet M Bosch
- Department of Pediatrics, Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Classic galactosemia is an inherited metabolic disease for which, at present, no therapy is available apart from galactose-restricted diet. However, the efficacy of the diet is questionable, since it is not able to prevent the insurgence of chronic complications later in life. In addition, it is possible that dietary restriction itself could induce negative side effects. Therefore, there is a need for an alternative therapeutic approach that can avert the manifestation of chronic complications in the patients. In this review, the authors describe the development of a novel class of pharmaceutical agents that target the production of a toxic metabolite, galactose-1-phosphate, considered as the main culprit for the cause of the complications, in the patients.
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