Bone microarchitecture and estimated bone strength in men with active acromegaly

Silva, Paula Pb; Amlashi, Fatemeh Ghazanfari; Yu, Elaine W.; Pulaski-Liebert, Karen J.; Gerweck, Anu V.; Fazeli, Pouneh K.; Lawson, Elizabeth A.; Nachtigall, Lisa B.; Biller, Beverly M. K.; Miller, Karen K.; Klibanski, Anne; Bouxsein, Mary L.; Tritos, Nicholas A.

doi:10.1530/eje-17-0468

Cited by 37 publications

(45 citation statements)

References 29 publications

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“…Bone turnover is probably a better indicator of bone quality 101,102 (LQ), and proactive evaluations of vertebral fractures with the morphometric approach are recommended at diagnosis and annually thereafter 103 (SR). Assessment of bone microarchitecture in men with acromegaly has shown that alterations in both cortical and trabecular bone occur, which further corroborates the limitations of using areal BMD to assess fracture risk in these patients 104 . Soft tissue and bony craniofacial overgrowth result in considerable airway obstruction and respiratory complications in at least 25% of patients with acromegaly and might not be reversible despite the achievement of adequate biochemical control 49 (MQ).…”

Section: Complicationssupporting

confidence: 53%

A Consensus Statement on acromegaly therapeutic outcomes

et al. 2018

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Section: Complicationssupporting

confidence: 53%

A Consensus Statement on acromegaly therapeutic outcomes

et al. 2018

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“…us, it will take a relatively long term of treatment to assess aBMD changes in AGHD patients by DXA. High-resolution peripheral quantitative computerized tomography (HR-pQCT) provides details of bone microarchitecture and volumetric bone mineral density (vBMD) [12,13]. In our previous report, we found that young adults with childhood-onset growth hormone deficiency (CO AGHD) have prominently impaired vBMD and bone microarchitecture [14].…”

Section: Introductionmentioning

confidence: 99%

Effects of 24 Weeks of Growth Hormone Treatment on Bone Microstructure and Volumetric Bone Density in Patients with Childhood-Onset Adult GH Deficiency

Yang

Yan

et al. 2020

International Journal of Endocrinology

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Objective. Adults with childhood-onset growth hormone deficiency (CO AGHD) have prominently impaired volumetric bone density (vBMD) and bone microarchitecture. Effects of recombinant human growth hormone (rhGH) on bone microarchitecture in CO AGHD were insufficiently evaluated. e objective of this study is to assess the effects of rhGH on bone microarchitecture and vBMD in CO AGHD patients. Design. In this single-center prospective study, nine CO AGHD patients received rhGH treatment for 24 weeks. High-resolution peripheral quantitative computerized tomography (HR-pQCT) of distal tibia and radius was performed at baseline and at the end of treatment. Main outcomes were vBMD and morphometric parameters from HR-pQCT. Results. After 24-week treatment, IGF-1 SDS gradually increased from −3.31 ± 1.56 to −1.92 ± 1.65 (p � 0.113). Serum phosphate (1.17 ± 0.17 vs. 1.35 ± 0.18 mmol/L, p � 0.030), alkaline phosphatase (83.6 ± 38.6 vs. 120.5 ± 63.7, p � 0.045), and β-CTX (0.67 ± 0.32 vs. 1.09 ± 0.58, p � 0.022) were significantly elevated. In distal tibia, total vBMD (200.2 ± 41.7 vs 210.3 ± 40.9 mg HA/cm 3 , p � 0.017), cortical area (89.9 ± 17.7 vs 95.5 ± 19.9 mm 2 , p � 0.032), and cortical thickness (0.891 ± 0.197 vs 0.944 ± 0.239 mm, p � 0.028) were significantly improved. Trabecular area decreased from 795.3 ± 280.9 to 789.6 ± 211.4 mm 2 (p � 0.029). Trabecular bone volume fraction increased from 0.193 ± 0.038 to 0.198 ± 0.036 (p � 0.027). In radius, cortical perimeter (74.1 ± 10.0 vs 75.0 ± 10.9 mm, p � 0.034), trabecular thickness (0.208 ± 0.013 vs 0.212 ± 0.013 mm, p � 0.008), trabecular separation (0.743 ± 0.175 vs 0.796 ± 0.199 mm, p � 0.019), and inhomogeneity of network (Tb.1/N.SD) (0.292 ± 0.087 vs 0.317 ± 0.096 mm, p � 0.026) were significantly improved, while trabecular number (1.363 ± 0.294 vs 1.291 ± 0.325 1/mm, p � 0.025) decreased significantly. Conclusions. Our results provide evidence for improvement of vBMD and bone microarchitecture in AGHD patients at a relatively early stage of rhGH treatment.

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“…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. Indeed, mechanical and radiographic studies indicate that reduced cortical thickness increases the risk of hip fractures …”

Section: Introductionmentioning

confidence: 99%

“…(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. Vertebral bodies must resist high and repetitive axial compression loads and if the trabecular bone is reduced, the stress on the cortical compartments increases and the vertebral bone's ability to resist compression forces decreases.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, mechanical and radiographic studies indicate that reduced cortical thickness increases the risk of hip fractures. (12,15,16) Hip-structure analysis (HSA) gives a DXA-based estimation of bone geometry and structure in the total femur region. (17)(18)(19)(20) The assessment of cortical thickness at the femoral neck, calcar, and proximal shaft can be derived from HSA and have been validated by pQCT measurements.…”

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.

show abstract

Bone microarchitecture and estimated bone strength in men with active acromegaly

Cited by 37 publications

References 29 publications

A Consensus Statement on acromegaly therapeutic outcomes

A Consensus Statement on acromegaly therapeutic outcomes

Effects of 24 Weeks of Growth Hormone Treatment on Bone Microstructure and Volumetric Bone Density in Patients with Childhood-Onset Adult GH Deficiency

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

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