Significant Inverse Correlation of Serum Levels of Osteoprotegerin (OPG) and Transferrin Saturation in Thalassemia Dependent Transfusion (TDT) Patients

Indra Wijaya, M Lucky Nurdiansyah Prameswara, Dimmy Prasetya, Laniyati Hamijoyo, Bachti Alisjahbana, Andri Reza Rahmadi


Background: Osteoporosis is a major problem in transfusion-dependent thalassemia patients (TDT) patients. Osteoprotegerin (OPG) is one of several bone markers that are closely associated with osteoporosis in TDT patients. OPG is a glycoprotein that functions as a feedback receptor for the Receptor Activator of Nuclear Factor kappa B Ligand (RANKL), which is an alpha tumor necrosis factor receptor. One of the causes of decreased bone mass density is iron toxicity, which can be identified by showing elevated transferrin saturation. Bone mass dual X-ray absorptiometry (DEXA) is a gold standard for the diagnosis of osteoporosis, these procedures are not commonly available in Indonesia. This study was conducted to analyze the correlation between serum levels of OPG and transferrin saturation in TDT patients. Methods: A correlational study with a cross-sectional approach analyzed data from TDT patients at Hemato-Oncology Medic Outpatient Clinic, Hasan Sadikin General Hospital, Bandung, Indonesia. Primary data were obtained through blood sampling and anthropometry measurement while secondary data were obtained from the patient’s medical records. OPG and transferrin saturation levels were assessed using the ELISA method. Research data were analyzed using the rank Spearman correlation test. Results: Data were collected from 51 research subjects (30 women dan 21 men). The median OPG level was 380 (170-1230) pg/mL and the median transferrin saturation level was 89.4 (66.7 – 96.2)%. Analysis of correlation showed a significant correlation between and transferrin saturation level with a coefficient value of r -0.539 and p-value <0.001. Conclusion: There was a significant inverse correlation between OPG with transferrin saturation in TDT patients.


OPG; transferrin saturation; osteoporosis; transfusion-dependent thalassemia


Stefanopoulos D, Papaioannou NA, Papavassiliou AG, et al. A contemporary therapeutic approach to bone disease in beta-thalassemia-a review. J Frailty Sarcopenia Falls. 2018;3(1):13.

Gaudio A, Xourafa A, Rapisarda R, Zanoli L, Signorelli SS, Castellino P. Hematological diseases and osteoporosis. Int J Mol Sci. 2020;21(10):3538.

De Sanctis V, Soliman AT, Elsefdy H, et al. Bone disease in β thalassemia patients: past, present and future perspectives. Metabolism. 2018;80:66-79.

Thavonlun S, Houngngam N, Kingpetch K, et al. Association of osteoporosis and sarcopenia with fracture risk in transfusion-dependent thalassemia. Sci Rep. 2023;13(1):16413.

Charoenngam N, Rittiphairoj T, Ponvilawan B. Fracture prevalence in thalassemia: A systematic review and meta-analysis. Arch Osteoporos. 2021;16, 171.

Tirtarahardja G, Setyohadi B, Weynand LS, Zhou Q. Bone mineral density reference values for Indonesian men and women; 2006. Available from: 297712953. Accessed Oct 10, 2023.

Atmakusuma TD, Tenggara JB. Correlation of transferrin saturation and serum ferritin with bone mass density in adult transfusion-dependent beta-thalassemia patients. J Blood Med. 2021:827-32.

Piga A. Impact of bone disease and pain in thalassemia. Hematology Am Soc Hematol Educ Program. 2017;2017(1):272-7.

Leecharoenkiat K, Lithanatudom P, Sornjai W, Smith DR. Iron dysregulation in beta-thalassemia. Asian Pac J Trop Med. 2016;9(11):1035-43.

Kuo TR, Chen CH. Bone biomarker for the clinical assessment of osteoporosis: recent developments and future perspectives. Biomarker research. 2017;5(1):1-9.

Çelik T, Sangün Ö, Ünal Ş. Assessment of biochemical bone markers of osteoporosis in children with thalassemia major. Ital J Pediatr. 2022;105.

Sanchez VM, Blanquer M, Moraleda JM, Salido EJ, Perez O. New Insights Into Pathophysiology of β -Thalassemia. Front Med. 2022;9.

Shah FT, Sayani F, Trompeter S, Drasar E, Piga A. Challenges of blood transfusions in β-thalassemia. Blood Reviews. 2019;37.

Rivera LMJ. Iron Overload. Medicina Universitaria. 2015;17(69):240-2.

Sagare A, Trivedi D. Assessment of transferrin saturation as an indicator of iron overload in homozygous & heterozygous form of thalassemia. JPCBS. 2014;5:668-73.

Jeremiah MP, Unwin BK, Greenawald MH, Casiano VE. Diagnosis and management of osteoporosis. Am Fam Physician. 2015;92(4):261-8.

Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022;17(1):58.

Elabscience. RANKL, OPG ELISA Kit. EB. 2021.

Koohmanaee S, Dabandi B, Baghersalimi A, et al. The probability of indicating Osteoprotegerin as a biomarker for osteoporosis in patients with thalassemia major. Iran J Ped Hematol Oncol. 2021;11(1):18-23.

Wong P, Fuller PJ, Gillespie MT, Milat F. Bone disease in thalassemia: a molecular and clinical overview. Endocrine Reviews. 2016;37(4):320-46.

Abd Allah N, Galal A, Hamed HM, et al. The roles of Osteoprotegerin and rankl in pathogenesis of Osteoporosis in Egyptian beta-thalassemia major patients. J Appl Sci Res. 2010;6(8):937-42.

Abd El-Moneim ES, Zolaly MA, Al-Hawsawi ZM, Abdelmoneim AA, Abosdera MM. Age-related changes in biochemical bone profile in thalassemic children. Pediatr Neonatol. 2018;59(2):189-97.

Maryam KA, Arshad NA; Estimation of osteoprotgrin level in B thalassemia patient. AIP Conference Proceedings. 2019;2144 (1).

Alfaqih MA, Bashir N, Saadeh R, Khader Y, Barqawi M, Alqudah, S. Dysregulation of the RANKL/RANK/OPG axis in thalassemia intermedia patients. BMC research notes. 2018;11(1):5.

Hashemieh M, Azarkeivan A, Radfar M, et al. Prevalence of Osteoporosis among thalassemia patients from Zafar adult thalassemia clinic, Iran. Iranian Journal of Blood and Cancer. 2014; 6(3):143-8.

Asadov C, Gafarova S, Aliyeva G. Bone abnormalities in Β-Thalassemia. Intermedia Blood Res Transfus J. 2017;1(1):1-3.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.