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

Godang, Kristin; Olarescu, Nicoleta Cristina; Bollerslev, Jens; Heck, Ansgar

doi:10.1530/eje-16-0340

Cited by 54 publications

(71 citation statements)

References 41 publications

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“…We analyzed anterior–posterior lumbar spine (LS; L 1 –L 4 ), bilateral proximal femur, dual total hip, and dual femoral neck and presented BMD for all these regions. Further details on calculating BMD LS have been described previously . Absolute BMD values (g/cm 2 ) and Z ‐scores were estimated by comparison to the reference population present in the software, suitable for clinical use in the Norwegian population .…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, the femoral neck and proximal hip are exposed to shear forces and bending moments, and therefore have distinct cortical structures. The increased risk for vertebral fractures in acromegaly does persist even after treatment; accordingly, we have recently demonstrated a decrease in trabecular bone score (TBS) following treatment in our large cohort of prospectively followed patients . The change in biomechanical properties of trabecular bone might alter and increase the stress in other compartments, as in cortical bone in the hip, potentially increasing the risk for hip fractures.…”

Section: Introductionmentioning

confidence: 92%

“…Further details on calculating BMD LS have been described previously. (10) Absolute BMD values (g/cm 2 ) and Zscores were estimated by comparison to the reference population present in the software, suitable for clinical use in the Norwegian population. (25) Daily calibration was performed.…”

Section: Biochemical Analysismentioning

confidence: 99%

“…(3,4) However, though the excess GH/IGF-1 correlates with increased bone mass in regions with predominantly cortical bone such as the femoral neck, (5)(6)(7)(8) biomechanical competence of trabecular bone, which dominates in the spine, is reduced in active acromegaly. (9,10) Thus, patients with newly diagnosed acromegaly have an increased risk of vertebral fractures, but low risk for peripheral fractures, (11) potentially because of increased CBT as assessed by pQCT. (12) The different mechanical demands to bone in a certain region determine the predominance of either trabecular or cortical bone.…”

Section: Introductionmentioning

confidence: 99%

“…The increased risk for vertebral fractures in acromegaly does persist even after treatment (1,14) ; accordingly, we have recently demonstrated a decrease in trabecular bone score (TBS) following treatment in our large cohort of prospectively followed patients. (10) The change in biomechanical properties of trabecular bone (9) might alter and increase the stress in other compartments, as in cortical bone in the hip, potentially increasing the risk for hip fractures. In addition, the effect of decreasing GH and IGF-1 following treatment of cortical structures in acromegaly is less known; a reduction in cortical thickness could further compromise bone structural integrity.…”

Section: Introductionmentioning

confidence: 99%

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Hip Structure Analyses in Acromegaly: Decrease of Cortical Bone Thickness After Treatment: A Longitudinal Cohort Study

et al. 2019

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Long‐standing growth hormone (GH) excess causes the skeletal clinical signs of acromegaly with typical changes in bone geometry, including increased cortical bone thickness (CBT). However, a high prevalence and incidence of vertebral fractures has been reported. The aim of this study was to assess the course of cortical bone dimensions in the hip by comparing patients with acromegaly and clinically nonfunctioning pituitary adenomas (NFPAs) at baseline and 1 year after pituitary surgery (1‐year PO) in a longitudinal cohort study. DXA was performed in patients with acromegaly (n = 56) and NFPA (n = 47). CBT in the femoral neck (CBTneck), calcar (CBTcalcar), and shaft (CBTshaft) were determined by hip structural analysis (HSA). CBT at baseline and the change to 1‐year PO were compared. Test results were adjusted for differences in gender distribution, age, and gonadal status. Cortical thickness analyses showed higher values [mm] at baseline in patients with acromegaly compared with NFPA: CBTneck median [25th; 75th] 6.2 [4.7; 8.0] versus 5.1 [4.1; 6.4] (p = 0.006), CBTcalcar 4.8 [4.2, 5.7] versus 4.0 [3.2, 4.5] (p < 0.001), CBTshaft 6.2 [5.1, 7.2] versus 5.2 [4.6, 6.0], (p = 0.003). In acromegaly, GH was correlated with CBTneck (r = 0.31, p = 0.020), whereas IGF‐1 was correlated with CBTcalcar (r = 0.39, p = 0.003) at baseline. In acromegaly, CBTneck decreased by 11.2%, p = 0.002 during follow‐up. Finally, the decrease in CBTneck and CBTcalcar in acromegaly was significant compared with NFPA (p = 0.023 and p = 0.017, respectively). Previous observations of increased CBT in acromegaly were confirmed with DXA‐derived HSA in a large, well‐defined cohort. The decline in CBT in acromegaly could contribute to the increased fracture risk in acromegaly despite increased bone dimensions and disease control. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Biochemical Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hip Structure Analyses in Acromegaly: Decrease of Cortical Bone Thickness After Treatment: A Longitudinal Cohort Study

et al. 2019

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Endocortical Trabecularization in Acromegaly: The Cause for the Paradoxically Increased Vertebral Fracture Risk?

Heck,

Godang,

Lekva

et al. 2023

JBMR Plus

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Growth hormone (GH) is nonphysiologically increased in acromegaly, stimulating target tissues directly and indirectly via insulin‐like growth factor type 1 (IGF‐1). Despite GH having anabolic effects on bone growth and renewal, the risk of vertebral fractures is paradoxically increased in acromegaly. We hypothesized that bone tissue compartments were differentially affected by hormonal alterations in active and controlled acromegaly. We aimed to study the effect of sex and gonadal status on long‐term outcome of bone mass and structure to understand the biomechanical competence of bone. We followed 62 patients with newly diagnosed acromegaly longitudinally (median 4.8 years after pituitary surgery) to investigate changes assessed by dual X‐ray absorptiometry (DXA), trabecular bone score (TBS), and hip structure analysis (HSA). At diagnosis, patients had increased bone mineral density (BMD) in most compartments compared with normative data (Z‐scores). Conversely, TBS Z‐score was decreased (Z = −0.64 (SD 1.73), p = 0.028). Following treatment of acromegaly, BMD increased further in compartments containing predominantly trabecular bone, such as the lumbar spine, in eugonadal and male subjects, while compartments with predominantly cortical bone, such as the hip and femoral neck, were unchanged. Total body measurements showed further increase in BMD independent of sex and gonadal status. TBS did not change. HSA revealed a significant decrease in cortical thickness in both sexes independent of gonadal status, whereas the overall size of bone (hip axis length and neck width) did not change over time. In conclusion, patients with acromegaly had increased bone mass and dimensions by DXA. Following normalization of disease activity, BMD increased mainly in compartments rich in trabecular bone, reflecting a closure of the remodeling space. However, HSA revealed a significant decrease in cortical thickness, implying endocortical trabecularization, potentially explaining the increased risk for incident vertebral fractures following treatment. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging

et al. 2023

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Purpose Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. Summary This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice. Supplementary Information ...

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

Cited by 54 publications

References 41 publications

Hip Structure Analyses in Acromegaly: Decrease of Cortical Bone Thickness After Treatment: A Longitudinal Cohort Study

Hip Structure Analyses in Acromegaly: Decrease of Cortical Bone Thickness After Treatment: A Longitudinal Cohort Study

Endocortical Trabecularization in Acromegaly: The Cause for the Paradoxically Increased Vertebral Fracture Risk?

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