Effects of GH-IGF-I excess and gonadal status on bone mineral density and body composition in patients with acromegaly

Madeira, Miguel; Neto, Leonardo Vieira; Lima, G. A. B. de; Moreira, Rodrigo O.; Mendonça, Laura Maria Carvalho de; Gadelha, Mônica R.; Farias, Maria Lúcia Fleiuss

doi:10.1007/s00198-009-1165-x

Cited by 32 publications

(22 citation statements)

References 27 publications

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“…Several reasons for these conflicting results can be highlighted, such as the small sample sizes in the previous studies, the lack of patient stratification and separate analysis (based on the gender, disease activity, and gonadal status) in some of these studies, and the measurement of the BMD at different skeletal sites (6,8,9,35,36). In the present study, the only differences (based on the DXA parameters) were higher BMDs and T-scores only in the LS of patients with active acromegaly, whereas gonadal status did not have a significant effect on the BMD (Z-score), consistent with our group's previously published results (24). When the HR-pQCT parameters were analyzed, the only significant difference between the patients with active vs controlled acromegaly was higher cortical densities in the distal tibias of the active group.…”

Section: Discussionsupporting

confidence: 92%

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Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Madeira

Neto

Paranhos-Neto

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

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Acromegaly appears to have a deleterious effect on trabecular bone microarchitecture, and in this specific population, the gonadal status might be more important than T2DM or acromegaly activity in determining bone health. High-resolution peripheral quantitative computed tomography seems promising for evaluating acromegalic bone properties and for addressing the limitations posed by dual-energy x-ray absorptiometry.

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Section: Discussionsupporting

confidence: 92%

“…Values of Z-scores ՅϪ2.0 were considered to be lower than the expected bone mass. The coefficient of variation for the BMD measurements in normal subjects at our institution is 1.5% in the LS and 2.3% in the femoral neck (24).…”

Section: Methodsmentioning

confidence: 82%

Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Madeira

Neto

Paranhos-Neto

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Several studies have shown that GH substitution/therapy effectively decreases total, and particularly visceral, fat in various populations, such as patients with adult-onset GH deficiency, Prader-Willi syndrome, or obesity [6,7,8]. However, data regarding the specific AT distribution, rather than total body fat, and associations with metabolic risk factors in patients with acromegaly are limited [9,10,11]. Recently, a new dual-energy X-ray absorptiometry (DXA) application for quantifying VAT in the android region of the body was developed [12].…”

Section: Introductionmentioning

confidence: 99%

The Metabolic Risk in Patients Newly Diagnosed with Acromegaly Is Related to Fat Distribution and Circulating Adipokines and Improves after Treatment

Olarescu

Heck²,

Godang³

et al. 2015

Neuroendocrinology

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Background/Aims: Adipose tissue (AT) distribution is closely related to metabolic disease risk. Growth hormone (GH) reduces visceral and total body fat mass and induces whole-body insulin resistance. Our aim was to assess the effects of total and visceral AT (VAT) distribution and derived adipokines on systemic insulin resistance and lipid metabolism in acromegaly. Methods: Seventy adult patients with active acromegaly (43 males, age 49 ± 14 years) were evaluated before treatment, and a subset (n = 30, 20 males) was evaluated after treatment for acromegaly. Body composition and VAT, glucose metabolism parameters, lipids, C-reactive protein, and selected adipokines (vaspin, omentin, adiponectin, and leptin) were measured. Results: At baseline, VAT was positively associated with glucose metabolism parameters and with lipids. GH, but not IGF-I, was negatively associated with all AT depots (visceral, trunk, limbs, and total; 0.41 ≤ r ≤ 0.61, p < 0.001 for all) and positively associated with vaspin (r = 0.31, p = 0.013). The fat deposition after treatment was predominantly located on trunk and visceral depots. The lipid profile partially improved, with increases in HDL and apolipoprotein A-I and a decrease in lipoprotein(a). Vaspin decreased and omentin increased. Adiponectin and leptin did not change significantly. The improvement in homeostasis model assessment for insulin resistance (HOMA-IR) was best predicted by the decreases in IGF-I and vaspin and the lack of an increase in trunk fat (R² = 0.59, p = 0.001). Conclusions: (1) VAT is a metabolic risk factor for patients with active acromegaly; (2) vaspin and omentin levels are influenced by the disease activity but are not associated with VAT mass; (3) fat deposition after treatment occurs predominantly on the trunk and in visceral depots, and (4) insulin resistance decreases and the lipid profile partially improves with treatment.

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“…With regard to musculoskeletal tissues in acromegaly, the effects of excess GH and IGF-I on BMD are conflicting. Some studies have described increased BMD in patients with active acromegaly [8][9][10], though aging, sex and hypogonadism in such patients correlate with decreased BMD [8,11]. GH excess causes an increase in bone turnover markers, such as bone formation and resorption markers [12].…”

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confidence: 99%

Rapid decline in bone turnover markers but not bone mineral density in acromegalic patients after transsphenoidal surgery

et al. 2014

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Growth hormone (GH) has growth and metabolic functions. It stimulates the production of insulinlike growth factor-I (IGF-I) in the liver. IGF-I mediates the growth promoting activities of GH. Knockout mouse models with disruption of GH receptor, IGF-I or IGF-I receptor, highlight the importance of GH and IGF-I in maintaining bone metabolism and bone mineral density (BMD) [1][2][3]. In human, lack of GH is associated with reduced BMD and osteoporosis is observed in patients with severe adult GH deficiency [4,5]. Furthermore, replacement therapy using recombinant human GH (rhGH) increases BMD in such patients [6,7]. These results indicate that GH and IGF-I play an important role in maintaining bone metabolism and BMD in adulthood, in addition to stimulating longitudinal bone growth in childhood. However, informationRapid decline in bone turnover markers but not bone mineral density in acromegalic patients after transsphenoidal surgery Abstract. Growth hormone (GH) and insulin-like growth factor-I (IGF-I) play important roles in maintaining bone metabolism and bone mineral density (BMD) in adulthood, in addition to stimulating longitudinal bone growth in childhood. However, information on the effect of GH excess on bone metabolism and BMD is incomplete and requires further analysis. The aim of this study is to clarify the effect of rapid decline in GH levels after transsphenoidal surgery (TSS) on bone metabolism in acromegalic patients. In this prospective study, 22 patients (11 males and 11 females) with active acromegaly underwent TSS. Bone formation marker (serum bone alkaline phosphatase: BAP), bone resorption marker (urinary type I collagen cross-linked N-telopeptide: urinary NTx) and BMD were measured before and at 3 and 12 months after TSS. BAP was significantly decreased at 12 months after TSS, but not at 3 months. Urinary NTx was significantly decreased at 3 and 12 months after TSS. BMD did not change after TSS. In conclusion, the rapid fall in GH level after TSS had no effect on BMD for up to 12 months after TSS despite the decrease in markers of bone formation and resorption.

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Effects of GH-IGF-I excess and gonadal status on bone mineral density and body composition in patients with acromegaly

Abstract: Our data support that GH-IGF-I excess and eugonadism have great influence on BC modifications and that the anabolic effects of GH-IGF-I on bone are, at least in part, dependent on these alterations in body composition.

Cited by 32 publications

References 27 publications

Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

The Metabolic Risk in Patients Newly Diagnosed with Acromegaly Is Related to Fat Distribution and Circulating Adipokines and Improves after Treatment

Rapid decline in bone turnover markers but not bone mineral density in acromegalic patients after transsphenoidal surgery

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