Prevalence of Vertebral Fractures in Men with Acromegaly

Mazziotti, Gherardo; Bianchi, Antonio; Bonadonna, Stefania; Cimino, Vincenzo; Patelli, Ilaria; Fusco, Alessandra; Pontecorvi, Alfredo; Marinis, Laura De; Giustina, Andrea

doi:10.1210/jc.2008-0791

Cited by 153 publications

(116 citation statements)

References 44 publications

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“…It is therefore to be expected that disease control in acromegaly will be followed by a decrease in bone turnover and a filling of the remodeling space followed by a relative increase in BMD (11,27), as seen in other endocrine disorders with coupled bone remodeling, following treatment (37,38). The decrease in TBS following treatment in this study, despite the increase in BMD, reflects that the two measures describe different properties of bone, especially in other conditions than postmenopausal osteoporosis (4), but are in alignment with the observed high incidence and prevalence of vertebral fractures seen in acromegaly (5,31,32,33,34).…”

Section: Discussionsupporting

confidence: 72%

“…Recently, several studies have shown a marked increase in vertebral fracture prevalence and incidence for both sexes in acromegaly (5,31,32,33,34), related to the duration of disease activity and gonadal status among others. These observations underscore the complexity of a chronic and devastating disease as acromegaly, for bone as a target organ with fracture as the ultimate end point (2).…”

Section: Discussionmentioning

confidence: 99%

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Treatment of acromegaly increases BMD but reduces trabecular bone score: a longitudinal study

Godang

Olarescu

Bollerslev

et al. 2016

European Journal of Endocrinology

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Context: Bone turnover is increased in acromegaly. Despite normalization of bone turnover after treatment, the risk for vertebral fractures remains increased. Gonadal status, but not BMD, is correlated with vertebral fractures. Trabecular bone score (TBS) is related to bone microarchitecture. Objective: The aim of this study is to assess the longitudinal change in TBS and BMD following treatment for acromegaly. Results: Following treatment, the mean TBS decreased by 3.0 (±7.0) %, whereas the BMD at the lumbar spine (LS) increased by 3.2 (±4.9) % (both P < 0.01). The changes in BMD LS and TBS were not correlated (P = 0.87). The TBS change was found to be −4.5 % (±6.7; P = 0.003) in men and −0.3 % (±6.8; P = 0.85) in women (P = 0.063 for interaction men vs women). The mean BMD LS increased in men +4.2 g/cm 2 (±4.3; P < 0.001), but not in women +1.5 g/ cm 2 (±5.6; P = 0.36); (P = 0.073 for interaction). BMD increased in the ultradistal radius and total body (both P < 0.01).The increase in BMD LS was associated with a decrease in P1NP and CTX-1 (P < 0.001) and with lower P1NP and CTX-1 at the follow-up (P < 0.02). Conclusion: Treatment of acromegaly affects TBS and BMD at LS in different manners. The reduction of bone turnover markers predicts the increase in BMD but not the decrease in TBS. The DXA changes were more pronounced in men. Alterations in trabecular bone architecture may explain the persistent fracture risk despite the increase in BMD after disease control.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Treatment of acromegaly increases BMD but reduces trabecular bone score: a longitudinal study

Godang

Olarescu

Bollerslev

et al. 2016

European Journal of Endocrinology

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“…In contrast, Bonadonna et al (15) found that in postmenopausal women with active acromegaly, the risk for VFs was high even in the presence of normal BMD, but that VFs were always associated with low BMD in controlled disease. The same group also demonstrated an increase in VF risk in men with acromegaly, especially in those with hypogonadism, irrespective of BMD (16). To date, the prevalence of fractures in relation with BMD has not been assessed in acromegalic patients after long-term biochemical control.…”

Section: Introductionmentioning

confidence: 91%

High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly

Wassenaar

Biermasz

Hamdy

et al. 2011

European Journal of Endocrinology

134

100

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Objective: To establish the prevalence of osteoporosis, vertebral fractures (VFs), and non-VFs in acromegaly patients with long-term controlled disease and factors potentially influencing fracture risk. Design: Case-control study. Patients and measurements: Eighty-nine patients (46% male, mean age: 58 years) were included. We studied VFs and non-VFs, bone mineral density (BMD), and markers of bone turnover. In 48 patients, BMD assessment was also obtained 7 years prior to the current study. To compare VF prevalence, data from a sample of the Dutch population (nZ3469) were used. Results: VF prevalence was 59% (men 64% and women 54%), significantly increased when compared with controls (odds ratio up to 6.5), and independent of the duration of disease control, BMD, markers of bone turnover, and acromegalic disease characteristics. Mean number of VFs per patient was 3.4G0.3 (range 1-8). There was no relationship between the number and severity of fractures, parameters of bone turnover, and follow-up BMD measurements. BMD did not change during prolongation of follow-up by 7 years of controlled acromegaly. Conclusion: There is a very high prevalence of VFs in acromegaly patients with long-term controlled disease, independently of BMD. In view of the significant morbidity and mortality associated with VFs in general and the inability of BMD to predict fracture risk in acromegalic patients, we propose to include VF assessment, for example by lateral conventional radiographs of the spine in the screening of patients with acromegaly, both at diagnosis and during follow-up after establishment of disease control.

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“…New techniques are needed to measure bone and joint integrity to assess better the effects of acromegaly treatment (MQ). [45][46][47][48] Different medications for acromegaly have different effects on glucose metabolism. SRLs might have a negative influence on glucose metabolism, but generally with marginal clinical relevance and most frequently in patients who do not have biochemical control of the disease.…”

Section: Comorbiditiesmentioning

confidence: 99%

Expert consensus document: A consensus on the medical treatment of acromegaly

et al. 2014

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| In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.

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Prevalence of Vertebral Fractures in Men with Acromegaly

Abstract: This study reports for the first time a high prevalence of osteoporotic vertebral fractures in an unselected acromegalic male population generally considered at low risk of osteoporosis, suggesting that complicated osteoporosis is an important comorbidity of acromegaly.

Cited by 153 publications

References 44 publications

Treatment of acromegaly increases BMD but reduces trabecular bone score: a longitudinal study

Treatment of acromegaly increases BMD but reduces trabecular bone score: a longitudinal study

High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly

Expert consensus document: A consensus on the medical treatment of acromegaly

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