Prevalence of morphometric vertebral fractures in “difficult” patients with acromegaly with different biochemical outcomes after multimodal treatment

Chiloiro, Sabrina; Mormando, Marilda; Bianchi, Antonio; Giampietro, Antonella; Milardi, Domenico; Bima, Chiara; Grande, Giuseppe; Formenti, Anna Maria; Mazziotti, Gherardo; Pontecorvi, Alfredo; Giustina, Andrea; Marinis, Laura De

doi:10.1007/s12020-017-1391-5

Cited by 35 publications

(26 citation statements)

References 25 publications

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“…The latter finding is consistent with the concept that VFs are a marker of skeletal fragility in acromegaly (116,117). Based on the hypothesis that the drugs used in acromegaly may have direct effects on peripheral targets independent of the biochemical control of the disease (118,119,120), some studies investigated the possible effects of SSAs and pegvisomant on fracture risk in acromegaly (114,121). However, the results of these studies were inconclusive since the design did not allow to discriminate the skeletal effects of the drugs from those on the activity of the underlying disease.…”

Section: Effects Of Acromegaly Therapy On Fracture Risksupporting

confidence: 83%

“…The persistent abnormalities in bone structure explain why fracture risk persists in some patients with cured acromegaly (7,8), particularly, when hypogonadism is present (7,114), diabetes mellitus coexists (115) or when pre-existing (i.e., prevalent) VFs are identified (7,8). The latter finding is consistent with the concept that VFs are a marker of skeletal fragility in acromegaly (116,117).…”

Section: Effects Of Acromegaly Therapy On Fracture Risksupporting

confidence: 73%

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MANAGEMENT OF ENDOCRINE DISEASE: Bone disorders associated with acromegaly: mechanisms and treatment

Mazziotti

Lania

Canalis

2019

European Journal of Endocrinology

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Growth hormone (GH) and insulin-like growth factor-I (IGF-I) exert physiological actions on the skeleton throughout life, by stimulating longitudinal bone growth in children, the acquisition of bone mass during adolescence and the maintenance of skeletal architecture in adults. When GH and IGF-I are secreted in excess, bone remodeling is enhanced leading to deterioration of bone microstructure and impairment of bone strength. Indeed, acromegaly causes skeletal fragility, and vertebral fractures are reported in a remarkable number of subjects exposed to GH and IGF-I excess. The management of skeletal fragility in acromegaly is a challenge, since the awareness of this complication is low, the prediction of fracture risk is difficult to ascertain, the risk of fractures remains after the control of acromegaly and the effectiveness of bone-active drugs is unknown. This review is an update on bone disorders associated with acromegaly and provides a perspective of possible therapeutic approaches based on emerging pathophysiological and clinical information.

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Section: Effects Of Acromegaly Therapy On Fracture Risksupporting

confidence: 83%

Section: Effects Of Acromegaly Therapy On Fracture Risksupporting

confidence: 73%

MANAGEMENT OF ENDOCRINE DISEASE: Bone disorders associated with acromegaly: mechanisms and treatment

Mazziotti

Lania

Canalis

2019

European Journal of Endocrinology

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“…Accordingly, fracture risk is highest in patients with long-standing active acromegaly. Biochemical control corrects bone turnover defects and protects against fracture risk (MQ)(81,(84)(85)(86). Lumbar spine trabecular bone score, related to bone microarchitecture, provides information on bone strength independent of BMD(80).…”

mentioning

confidence: 99%

A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update

Giustina

Barkan

Beckers

et al. 2019

The Journal of Clinical Endocrinology &Amp; Metabolism

249

197

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Objective The aim of the Acromegaly Consensus Group was to revise and update the consensus on diagnosis and treatment of acromegaly comorbidities last published in 2013. Participants The Consensus Group, convened by 11 Steering Committee members, consisted of 45 experts in the medical and surgical management of acromegaly. The authors received no corporate funding or remuneration. Evidence This evidence-based consensus was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence following critical discussion of the current literature on the diagnosis and treatment of acromegaly comorbidities. Consensus Process Acromegaly Consensus Group participants conducted comprehensive literature searches for English-language papers on selected topics, reviewed brief presentations on each topic, and discussed current practice and recommendations in breakout groups. Consensus recommendations were developed based on all presentations and discussions. Members of the Scientific Committee graded the quality of the supporting evidence and the consensus recommendations using the GRADE system. Conclusions Evidence-based approach consensus recommendations address important clinical issues regarding multidisciplinary management of acromegaly-related cardiovascular, endocrine, metabolic, and oncologic comorbidities, sleep apnea, and bone and joint disorders and their sequelae, as well as their effects on quality of life and mortality.

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“…No treatments with growth hormones (GH) were noted in this cohort, and not all patients werescreened for growth hormone (GH) deficiency using validated dynamic testing, or for vitamin D concentrations and active smoking status, so it is possible that these parameters influenced the bone health status in some patients [33][34][35][36][37][38] . Patients with osteopenia and osteoporosis have been grouped together as patients with impaired BMD, and statistical uncertainty in this sample size precluded us from discriminating between osteopenia and osteoporosis in both men and women.…”

Section: Study Limitationsmentioning

confidence: 99%

Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas

Andereggen

Frey

Andres

et al. 2021

Sci Rep

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While prolactinoma patients have high bone turnover, current data are inconclusive when it comes to determining whether correction of hyperprolactinemia and associated hypogandism improves osteodensitometric data in men and women over the long term. In a large cohort of including 40 men and 60 women, we studied the long-term impact of prolactinoma treatment on bone mineral density (BMD) in men versus women, assessed adverse effects of a primary surgical or medical approach, and evaluated data for risk factors for impaired BMD at last follow-up using multivariate regression analyses. Median duration of follow-up was 79 months (range 13–408 months). Our data indicate that the prevalence of impaired BMD remained significantly higher in men (37%) than in women (7%, p < 0.001), despite the fact that hyperprolactinemia and hypogonadism are under control in the majority of men. We found that persistent hyperprolactinemia and male sex were independent risk factors for long-term bone impairment. Currently, osteoporosis prevention and treatment focus primarily on women, yet special attention to bone loss in men with prolactinomas is advised. Bone impairment as “end organ” reflects the full range of the disease and could become a surrogate marker for the severity of long-lasting hyperprolactinemia and associated hypogonadism.

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Prevalence of morphometric vertebral fractures in “difficult” patients with acromegaly with different biochemical outcomes after multimodal treatment

Abstract: Vertebral fractures are a frequent complication of long-standing active acromegaly. When patients are treated with Pegvisomant, vertebral fractures may occur in close relationship with active acromegaly and coexistent untreated hypogonadism.

Cited by 35 publications

References 25 publications

MANAGEMENT OF ENDOCRINE DISEASE: Bone disorders associated with acromegaly: mechanisms and treatment

MANAGEMENT OF ENDOCRINE DISEASE: Bone disorders associated with acromegaly: mechanisms and treatment

A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update

Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas

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