From the Guidelines
Polycythemia vera (PV) is associated with decreased bone density and an increased risk of fractures, although the provided evidence does not directly address this relationship. However, based on the general understanding of the disease and its treatment, it is reasonable to infer that patients with PV may experience reduced bone mineral density due to the chronic myeloproliferative nature of the disease and its treatments. The chronic myeloproliferative nature of PV leads to increased bone turnover with enhanced osteoclast activity (cells that break down bone) 1. Additionally, common treatments for PV, particularly hydroxyurea and phlebotomy therapy, may contribute to bone loss over time 1. Phlebotomy can deplete iron stores, which affects bone metabolism, while cytoreductive therapies may directly impact bone-forming cells. Patients with PV should undergo regular bone density screening, especially those on long-term treatments or with additional risk factors for osteoporosis. Preventive measures including calcium and vitamin D supplementation, weight-bearing exercise, and in some cases, bone-specific medications like bisphosphonates may be necessary to reduce fracture risk in these patients. It is essential to consider the most recent and highest quality study available, which in this case, does not directly address the relationship between PV and bone density, but the general principles of managing PV and its potential effects on bone health can be applied 1. Some key points to consider in the management of PV include:
- Phlebotomy to maintain the hematocrit at less than 45%
- Low-dose aspirin
- Cytoreduction in high-risk patients
- Management of generic cardiovascular risk factors
- Advice to stop smoking. These measures can help reduce the risk of thrombosis and other complications associated with PV, but the specific relationship between PV and bone density requires further investigation.
From the Research
Association between Polycythemia Vera and Bone Density
- Polycythemia vera (PV) has been associated with decreased bone density and fractures in some studies 2.
- A mouse model of PV showed a decrease in trabecular bone mass and decreased osteoblast activity, suggesting a link between PV and bone loss 2.
- Another study found that polycythemia caused by elevated circulating erythropoietin (EPO) also results in bone loss, which may have implications for patients treated with recombinant EPO 2.
Clinical Features and Complications of Polycythemia Vera
- PV is a myeloproliferative neoplasm characterized by erythrocytosis, leukocytosis, and thrombocytosis, with clinical features including reduced life expectancy due to thrombosis, hemorrhage, and transformation to myelofibrosis or acute myeloid leukemia 3, 4.
- The JAK2V617F mutation is present in more than 95% of patients with PV and is used in diagnosis and prognosis 3, 4.
- Treatment recommendations for PV include control of vascular risk factors, therapeutic phlebotomy, and low-dose aspirin, with cytoreductive agents offered to patients at higher risk of thrombosis 3, 4.