Progression of vertebral fractures in long-term controlled acromegaly: a 9-year follow-up study

in European Journal of Endocrinology
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  • 1 Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, the Netherlands
  • 2 Department of Neurosurgery, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, the Netherlands
  • 3 Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
  • 4 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
  • 5 Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

Correspondence should be addressed to N R Biermasz Email n.r.biermasz@lumc.nl
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Objective:

Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess results in both reversible and irreversible musculoskeletal damage, including increased vertebral fracture (VF) risk. The prevalence of VFs is approximately 60% in controlled acromegaly patients, and these VFs can progress in time. We aimed to identify the course of VFs in a cohort of acromegaly patients in long-term remission and their associated risk factors during prolonged follow-up.

Methods:

Thirty-one patients with acromegaly (49% female, median age 60 years (IQR 53–66)), who were in remission for ≥2 years, were included in this longitudinal, prospective, follow-up study. Spine radiographs of vertebrae Th4 to L4 were assessed for VFs using the Genant score, at baseline, after 2.6 years and 9.1 years. Progression was defined as either a new fracture or a ≥1-point increase in Genant score.

Results:

The prevalence of VF at baseline was 87% (27/31 patients). Progression of VFs was observed in eleven patients (35.5%) during the 9.1-year follow-up period, with a total incidence rate of 65.5 per 1000 person years (males 59.8 per 1000 person years vs females 71.6 per 1000 person years). Patients treated with surgery or radiotherapy had a higher risk of VF progression in this cohort (P = 0.030).

Conclusions:

In this cohort of long-term, well-controlled acromegalic patients, the prevalence and progression of VFs was high, showing that the deleterious effects of GH and IGF-1 excess on bone persist despite achievement of longstanding remission.

 

     European Society of Endocrinology

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