Impaired bone microarchitecture is involved in vertebral fracture (VF) development among acromegaly patients.
Aim of the study
Comparison of DXA-derived bone parameters, areal BMD (aBMD), trabecular bone score (TBS) and 3D-SHAPER parameters in acromegaly patients with healthy controls.
This cross-sectional study evaluated acromegaly patients and a control group of healthy subjects. In all subjects, a single measurement of pituitary axis hormone levels, bone turnover markers, aBMD, (total hip (TH) and lumbar spine (LS)), TBS and 3D-SHAPER of the proximal femur region was performed. All subjects underwent DXA assessment of VF using the semiquantitative approach.
One hundred six patients with acromegaly (mean age 56.6 years, BMI 30.2 kg/m2) and 104 control subjects (mean age 54.06 years, 28.4 BMI kg/m2) were included. After adjustment for weight, LS aBMD, TBS and TH trabecular volumetric BMD (vBMD) remained lower (P = 0.0048, <0.0001 and <0.0001, respectively) while cortical thickness (Cth) at TH and neck remained thicker (P = 0.006) in acromegaly patients compared with controls. The best multivariate model (model 1) discriminating patients with and without acromegaly included TBS, TH trabecular vBMD and TH Cth parameters (all P < 0.05). Twenty-two VFs (13 acromegaly subjects) were recognized. In these subjects after adjustment for age, FN aBMD, TH cortical sBMD and TH cortical vBMD remained significantly associated with the prevalent VF (OR = 2.69 (1.07–6.78), 2.84 (1.24–6.51) and 2.38 (1.11–5.10) for neck aBMD, TH cortical sBMD and TH cortical vBMD respectively)). The AUCs were similar for each parameter in this model.
Acromegaly patients, regardless of VF presence, have lower trabecular bone quantitative parameters, but those with VFs had decreased cortical density.
MazziottiGBiagioliEMaffezzoniFSpinelloMSerraVMaroldiRFlorianiIGiustinaA.Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis. Journal of Clinical Endocrinology and Metabolism2015100384–394. (https://doi.org/10.1210/jc.2014-2937)
KamenickyPMazziottiGLombesMGiustinaAChansonP.Growth hormone, insulin-like growth factor-1, and the kidney: pathophysiological and clinical implications. Endocrine Reviews201435234–281. (https://doi.org/10.1210/er.2013-1071)
RiggsBLRandallRVWahnerHWJowseyJKellyPJSinghM.The nature of the metabolic bone disorder in acromegaly. Journal of Clinical Endocrinology and Metabolism197234911–918. (https://doi.org/10.1210/jcem-34-6-911)
BonadonnaSMazziottiGNuzzoMBianchiAFuscoADe MarinisLGiustinaA.Increased prevalence of radiological spinal deformities in active acromegaly: a cross-sectional study in postmenopausal women. Journal of Bone and Mineral Research2005201837–1844. (https://doi.org/10.1359/JBMR.050603)
MazziottiGBianchiAPorcelliTMormandoMMaffezzoniFCristianoAGiampietroADe MarinisLGiustinaA.Vertebral fractures in patients with acromegaly: a 3-year prospective study. Journal of Clinical Endocrinology and Metabolism2013983402–3410. (https://doi.org/10.1210/jc.2013-1460)
ClaessenKMKroonHMPereiraAMAppelman-DijkstraNMVerstegenMJKloppenburgMHamdyNABiermaszNR.Progression of vertebral fractures despite long-term biochemical control of acromegaly: a prospective follow-up study. Journal of Clinical Endocrinology and Metabolism2013984808–4815. (https://doi.org/10.1210/jc.2013-2695)
MelmedSCasanuevaFFKlibanskiABronsteinMDChansonPLambertsSWStrasburgerCJWassJAGiustinaA.A consensus on the diagnosis and treatment of acromegaly complications. Pituitary201316294–302. (https://doi.org/10.1007/s11102-012-0420-x)
UelandTBollerslevJGodangKMullerFFrolandSSAukrustP.Increased serum osteoprotegerin in disorders characterized by persistent immune activation or glucocorticoid excess – possible role in bone homeostasis. European Journal of Endocrinology2001145685–690. (https://doi.org/10.1530/eje.0.1450685)
ScillitaniAChiodiniICarnevaleVGiannatempoGMFruscianteVVillellaMPileriMGuglielmiGDi GiorgioAModoniSet al. Skeletal involvement in female acromegalic subjects: the effects of growth hormone excess in amenorrheal and menstruating patients. Journal of Bone and Mineral Research1997121729–1736. (https://doi.org/10.1359/jbmr.19184.108.40.2069)
DiamondTNeryLPosenS.Spinal and peripheral bone mineral densities in acromegaly: the effects of excess growth hormone and hypogonadism. Annals of Internal Medicine1989111567–573. (https://doi.org/10.7326/0003-4819-111-7-567)
Dalle CarbonareLMichelettiVCosaroEValentiMTMottesMFranciaGDaviMV.Bone histomorphometry in acromegaly patients with fragility vertebral fractures. Pituitary20182156–64. (https://doi.org/10.1007/s11102-017-0847-1)
MaffezzoniFMaddaloMFraraSMezzoneMZorzaIBaruffaldiFDogliettoFMazziottiGMaroldiRGiustinaA.High-resolution-cone beam tomography analysis of bone microarchitecture in patients with acromegaly and radiological vertebral fractures. Endocrine201654532–542. (https://doi.org/10.1007/s12020-016-1078-3)
MadeiraMNetoLVde Paula Paranhos NetoFBarbosa LimaICCarvalho de MendoncaLMGadelhaMRFleiuss de FariasML.Acromegaly has a negative influence on trabecular bone, but not on cortical bone, as assessed by high-resolution peripheral quantitative computed tomography. Journal of Clinical Endocrinology and Metabolism2013981734–1741. (https://doi.org/10.1210/jc.2012-4073)
MalgoFHamdyNATPapapoulosSEAppelman-DijkstraNM.Bone material strength index as measured by impact microindentation is low in patients with fractures irrespective of fracture site. Osteoporosis International2017282433–2437. (https://doi.org/10.1007/s00198-017-4054-8)
GodangKOlarescuNCBollerslevJHeckA.Treatment of acromegaly increases BMD but reduces trabecular bone score: a longitudinal study. European Journal of Endocrinology2016175155–164. (https://doi.org/10.1530/EJE-16-0340)
HumbertLMartelliYFonollaRSteghoferMDi GregorioSMaloufJRomeraJBarqueroLM.3D-DXA: assessing the femoral shape, the trabecular macrostructure and the cortex in 3D from DXA images. IEEE Transactions on Medical Imaging20173627–39. (https://doi.org/10.1109/TMI.2016.2593346)
FreitasLAmorimTHumbertLFonollaRFlourisADMetsiosGSJamurtasAZKoutedakisY.Cortical and trabecular bone analysis of professional dancers using 3D-DXA: a case-control study. Journal of Sports Sciences2018 Epub. (https://doi.org/10.1080/02640414.2018.1483178)
GifreLHumbertLMuxiADel RioLVidalJPortellEMonegalAGuanabensNPerisP.Analysis of the evolution of cortical and trabecular bone compartments in the proximal femur after spinal cord injury by 3D-DXA. Osteoporosis International201829201–209. (https://doi.org/10.1007/s00198-017-4268-9)
HumbertLHazrati MarangalouJDel Rio BarqueroLMvan LentheGHvan RietbergenB.Technical note: cortical thickness and density estimation from clinical CT using a prior thickness-density relationship. Medical Physics2016431945. (https://doi.org/10.1118/1.4944501)
KatznelsonLLawsERJr.MelmedSMolitchMEMuradMHUtzAWassJA & Endocrine Society. Acromegaly: an Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism2014993933–3951. (https://doi.org/10.1210/jc.2014-2700)
ChamberlainJJRhinehartASShaeferCFJrNeumanA.Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association standards of medical care in diabetes. Annals of Internal Medicine2016164542–552. (https://doi.org/10.7326/M15-3016)
PooleKETreeceGMGeeAHBrownJPMcClungMRWangALibanatiC.Denosumab rapidly increases cortical bone in key locations of the femur: a 3D bone mapping study in women with osteoporosis. Journal of Bone and Mineral Research20153046–54. (https://doi.org/10.1002/jbmr.2325)
NicksKMAminSMeltonLJ3rdAtkinsonEJMcCreadyLKRiggsBLEngelkeKKhoslaS.Three-dimensional structural analysis of the proximal femur in an age-stratified sample of women. Bone201355179–188. (https://doi.org/10.1016/j.bone.2013.02.009)
GenantHKJergasMPalermoLNevittMValentinRSBlackDCummingsSR.Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis the Study of Osteoporotic Fractures Research Group. Journal of Bone and Mineral Research199611984–996. (https://doi.org/10.1002/jbmr.5650110716)
ReaJALiJBlakeGMSteigerPGenantHKFogelmanI.Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporosis International200011660–668. (https://doi.org/10.1007/s001980070063)
Hoyer-KuhnHKnoopKSemlerOKuhrKHellmichMSchoenauEKoerberF.Comparison of DXA scans and conventional X-rays for spine morphometry and bone age determination in children. Journal of Clinical Densitometry201619208–215. (https://doi.org/10.1016/j.jocd.2015.04.006)