Objective Acromegaly is associated with increased vertebral fracture (VFs) risk not correlated to bone mineral density (BMD). Trabecular bone score (TBS), related to bone microarchitecture, provides information on bone strength. This cross‐sectional study considered the usefulness of TBS and BMD to assess bone status in long‐term controlled acromegalic patients. Design, patients, measurements 26 acromegaly patients (14 female and 12 males) were included in the study. A further 117 subjects were recruited as controls (58 females and 57 males). BMD was measured using dual‐energy X‐ray absorptiometry (DXA), TBS was obtained applying Medimaps software 2.0. Biochemical parameters were determined by standardized techniques. Results 73% of patients with acromegaly exhibited normal lumbar spine (LS) BMD. TBS was normal in 38% of acromegalic patients and partially degraded or degraded in 31% of patients, respectively. No differences were found in LS BMD between acromegalic patients and controls. TBS values were significantly lower in patients with acromegaly (1.27 ± 0.13 vs. 1.35 ± 0.17, p = .01). Postsurgical remission was associated with higher TBS values (1.35 ± 0.10 vs. 1.23 ± 0.13, p = .02) and pituitary radiotherapy treatment with lower TBS values (1.18 ± 0.12 vs. 1.31 ± 0.12, p = .004). On multivariate analysis, age, BMI and LS BMD were predictors of TBS changes in patients with acromegaly (p < .05). Conclusions Patients with long‐term controlled acromegaly can exhibit deterioration of bone microstructure measured with TBS, despite BMD measurement not showing bone loss. Our study suggests that TBS is useful for monitoring the bone status changes in acromegalic patients.

SummaryThe aim of this study was to analyse the effect of risedronate on Trabecular Bone Score in liver transplant patients with low bone mass, during 1-year follow-up. In this retrospective cohort study, trabecular bone score (TBS) was calculated from dual X-ray absorptiometry images of the lumbar spine (LS), collected from a prospective randomized open-label 1-year trial performed in liver recipient patients. A total of 89 patients with osteopenia or osteoporosis were randomized to receive RIS plus calcium and vitamin D3 or calcium and vitamin D3. TBS was low in both groups at baseline, 6 and 12 months. Baseline TBS at the LS showed degraded microarchitecture in 22.8% of patients, partially degraded in 40.3%, and normal values in 36.8% of the patients. After 1 year of treatment, no difference in TBS was observed between both groups. No correlations were found between bone mineral density (BMD) and TBS values at any follow-up time point. No relationship was found between BMD, TBS or immunosuppressive drugs with incidental fracture. No significant effect in TBS was observed in liver transplant patients treated with RIS or calcium and vitamin D3 after 1 year of follow-up. In these patients, the clinical usefulness of this new tool should be established.

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Objective: Erdheim-Chester disease (ECD) is a rare, non-Langerhans histiocytosis of unknown origin with characteristic radiologic and histologic features. Methods: This report describes a patient with multiple endocrine manifestations in the context of this uncommon disease. Results: A 78-year-old man presented with polyuria, polydypsia, fever, and a constitutional syndrome. Investigations revealed central diabetes insipidus, hypogonadism with inappropriate gonadotropin levels, and mild hyperprolactinemia. Pituitary magnetic resonance imaging showed stalk thickening and absence of the normal bright signal from the posterior pituitary lobe. Orchiectomy biopsy support the diagnosis of ECD, and therapy with peginterferon alfa-2a was initiated. Conclusion: ECD is a multisystemic and heterogeneous clinicopathologic condition. This disease should be considered in patients with diabetes insipidus, hyperprolactinemia, and hypogonadism in the setting of a multi-organ disease. (AACE Clinical Case Rep. 2017;3:e111-e115) Abbreviations: CT = computed tomography; DI = diabetes insipidus; ECD = Erdheim-Chester disease; IGF-1 = insulin-like growth factor 1; 18 FDG-PET/CT = fluorodeoxyglucose-positron emission tomography/computed tomography e112 Multisystemic Involvement in ECD, AACE Clinical Case Rep. 2017;3(No. 2)