High prevalence of radiological vertebral fractures in women with prolactin-secreting pituitary adenomas

Abstract

Hyperprolactinemia may cause bone loss but data on fractures are scanty. The aim of this study was to evaluate the prevalence of vertebral fractures in women with prolactin (PRL)-secreting adenoma. In this cross-sectional study, 78 women (median age 45.5 years, range: 20-81) with PRL-secreting pituitary adenoma (66 with microadenoma and 12 with macroadenoma) and 156 control subjects, with normal PRL values and with comparable age to patients with hyperprolactinemia, were evaluated for vertebral fractures by a morphometric approach and for bone mineral density (BMD) by a dual-energy X-ray absorptiometry at lumbar spine. Vertebral fractures were shown in 25 patients with PRL-secreting adenoma (32.6%) and in 20 controls (12.8%, P < 0.001). Fractured patients were significantly older (P < 0.001) and had lower BMD T-score (P < 0.001), longer duration of disease (P < 0.001), higher serum PRL (P = 0.004) and lower serum IGF-I (P < 0.001) values as compared to patients who did not fracture. The prevalence of vertebral fractures was significantly (P < 0.001) higher in post-menopausal women with PRL-secreting adenoma as compared to pre-menopausal patients. Fractures occurred more frequently (P = 0.01) in patients with untreated hyperprolactinemia versus patients treated with cabergoline. Logistic regression analysis demonstrated that duration of disease maintained a significant correlation with vertebral fractures (odds ratio 1.16, C.I. 95% 1.02-1.33) even after correction for age, menopausal status, treatment with cabergoline, BMD, serum IGF-I and serum PRL values. Hyperprolactinemia is associated with high prevalence of radiological vertebral fractures in women with PRL-secreting adenoma.

Vertebral fractures in males with prolactinoma

“…The presumed disease duration was calculated from the time of appearance of symptoms probably related to the adenoma or hyperprolactinemia, such headache, visual field defects, impairment of libido and erectile dysfunction. The median duration of disease was 4 years (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. At the time of the study, 23 patients were on treatment with cabergoline whereas 9 had never been treated for hyperprolactinemia.…”

“…An increase in bone resorption with low bone mineral density (BMD) has been shown to occur frequently in hypogonadal males and females with hyperprolactinemia [6]. Data on the hard end-point of bone loss in hyperprolactinemia, i.e., fragility fractures, are scanty and focused on women with prolactinoma [7,8], whereas it is still unknown whether there may be a more general increased risk of osteoporotic fractures in this clinical setting.…”

Pituitary disorders and osteoporosis

“…In female patients prevalence of VFs was associated with the duration of the disease independently of the effects of hypopituitarism, age, BMD, serum PRL levels, and treatment with dopaminergic drugs [24]. Fractures were more frequent in patients with untreated hyperprolactinemia in comparison with patients treated with cabergoline [18,24]. Dopamine agonist therapy restores gonadal function and increases vertebral BMD in most hyperprolactinemic women [19,20].…”

Clinical management of osteoporotic vertebral fracture treated with percutaneous vertebroplasty

“…In fact, secondary OP may be related to an underlying cause, like lifestyle factors, nutritional deficiencies, endocrinopathies, systemic affections (myeloma multiple, mastocytosis), or chronic drugs intake (immunosuppressive agents, glucocorticoids, etc.) (3)(4)(5)(6)(7). In both cases, bone loss results in increased susceptibility to fracture in different sites (mainly vertebrae, then femur, wrist) (8).…”