However, little data about the prevalence of hypovitaminosis D in patients with haemophilia have been reported [4, 12]. The aim of our observational study was to compare Vitamin D levels, bone metabolism markers and BMD in haemophilic patients with Rapamycin or without viral co-infections. Seventy-eight adult patients (pts) with severe or moderate haemophilia A and B, aged 20–73 years, treated on demand or with secondary prophylaxis, attending to Haemophilia Center of A.O.U. Careggi in Florence (Italy) were included in the study. We subdivided them into three groups of 26 pts each on the basis of absence (uninfected group) or presence of transfusional-related

viral infections (HCV mono-infected or HIV-HCV co-infected groups). The size of each group (n = 26) was designed according to the number of co-infected pts attending our centre. The three groups were matched on the following characteristics: Peptide 17 clinical trial age, height, weight, body mass index (BMI) and chronic untreated HCV infection with homogeneous viral loads (in the order of 106). All pts gave informed consent, and the study protocol was approved by the institutional medical ethics committee of University Hospital of Florence. In all groups the severity of haemophilic arthropathy was evaluated according to the World Federation of Haemophilia orthopaedic joint scale (WFH

score) [13]. Radiographs of the knees and ankles were scored according to the Pettersson method [14]. The BMD was assessed with DXA, using a QDR-4500A scanner, S/N 45806 (Hologic, Waltham, MA). As our pts were relatively young, we chose to use the Z-score, with values from −1 to −2 indicating osteopenia and Z-score values below −2 indicating osteoporosis, according to guidelines devised by the International Society for Clinical Densitometry (ISCD), for pts aged less than 50 years [7, 15, 16]. All pts were imaged at total femoral area (F) and at lumbar region from L1 to L4 (L). According to the Italian Guidelines on diagnosis, prevention and treatment of osteoporosis [17], the following blood tests were performed: calcium, phosphorus, albumin, creatinine, creatinine clearance with MDRD equation

to estimate glomerular filtration rate (GFR) [18], 25-hydroxyvitamin D (25-OH Vit D), parathyroid hormone (PTH), TSH and testosterone. The following selleck kinase inhibitor urinary tests were done on 24-h collection specimens: calcium, phosphorus and proteinuria (defined as ≥ +1 on urine dipstick exam on at least two consecutive urine analyses) in HIV pts treated with tenofovir disoproxil fumarate. Markers of bone resorption that were analysed included: serum amino-terminal telopeptide of type 1 collagen (NTx) and urinary piridinoline. Markers of bone formation assessed were serum bone-specific alkaline phosphatase (b-ALP) and serum osteocalcin. The first group was composed of 26 pts with haemophilia and HIV/HCV co-infection. Twenty of 26 pts (77%) had severe haemophilia A (FVIII:C < 1%), three of 26 (11.