Ep158: Iron infusions and fracture risk. A safety signal for ferric carboxymaltose

One in twenty Australian women of reproductive age are treated with intravenous iron supplementation, almost exclusively with ferric carboxymaltose. Usually sold under the name Ferinject or also Ferricarbo and Ferivo, this formulation is well-known to reduce serum phosphate in 50 to 70% of patients taking it, recently published findings reveal that it is associated with a significant increase in fracture risk and osteomalacia.
 
Cohort studies presented in July in the journal Blood showed that the risk of bone events in the seven years after a single infusion was two to three times higher in women receiving ferric carboxymaltose, compared to those receiving ferric derisomaltose, also known as Monofer. 

The researchers followed up these observations with experiments in a mouse model of anaemia, indicating that the iron is deposited directly in developing bone. The inhibitory action on development bone-forming cells seem to occur independently of previously known signaling pathways.
 
 In this podcast we hear from lead investigator, Professor Heinz Zoller of the Medical University of Innsbruck and Christian Doppler Laboratory for Iron and Phosphate Biology. Professors Luke Grzeskowiak (Flinders University, Adelaide) and Ian Morison (University of Otago, Dunedin) also discuss the implications of these findings for prescribing, regulation and funding of iron infusions in Australia and New Zealand.

Chapters
8:58     Cohort studies showing fracture risk
24:37   Mouse models and molecular pathways
29:45   Other risks of hypophosphataemia
42:19   Prescribing landscape

Guests
Professor Heinz Zoller (Medical University of Innsbruck; Christian Doppler Laboratory for Iron and Phosphate Biology)
 Emeritus Professor Ian Morison PhD FRCPA(Haem) (Awanui labs; University of Otago, Dunedin)
Associate Professor Luke Grzeskowiak PhD FANZCAP (Flinders University; Monash University; SA Pharmacy)

Production
Production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Blacklight’ by John B. Lund and ‘Abyss’ by Luwaks. Feedback on this episode kindly provided by doctors Fionnuala Fagan, Marion Leighton, Aidan Tan, David Arroyo, Hugh Murray and Maansi Arora, as well as advisors Paul Cooper PhD and Kathryn Smith PhD. Image by Stockbyte purchased from Getty Images. 

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.

Key References
Ferric carboxymaltose increases fracture risk in patients and reduces bone formation in mice with iron deficiency anemia [Blood. 2026]
A bone to pick with ferric carboxymaltose [Blood. 2026]
Increasing utilisation of intravenous iron among Australian women of reproductive age, 2013-2024: an Australian population-based study [IMJ. 2026]