New tools for bone health assessment in secreting pituitary adenomas

Uygur, Meliha Melin; Frara, Stefano; Filippo, Luigi di; Giustina, Andrea

doi:10.1016/j.tem.2023.01.006

Cited by 9 publications

(6 citation statements)

References 77 publications

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“…On the other side, it should be emphasized that the evaluation of clinical fractures is not a sensitive method and, therefore, is not the ideal procedure to study the incidence of skeletal health problems in patients with hypoparathyroidism. Recent data showed that a morphometric approach is essential for evaluating bone health in patients with endocrine disorders known to affect skeletal health ( 38 ). Therefore, the proactive search of clinically asymptomatic fractures by this method has been recognized as one of the most useful tools in these patients ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

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Incident comorbidities in patients with chronic hypoparathyroidism after thyroidectomy: a multicenter nationwide study

Díez,

Anda,

Pérez-Corral

et al. 2024

Front. Endocrinol.

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PurposePopulation-based and registry studies have shown that chronic hypoparathyroidism is accompanied by long-term complications. We aimed to evaluate the risk of incident comorbidity among patients with chronic postsurgical hypoparathyroidism in real-life clinical practice in Spain.MethodsWe performed a multicenter, retrospective cohort study including patients with chronic postsurgical hypoparathyroidism lasting ≥3 years with at least a follow-up visit between January 1, 2022 and September 15, 2023 (group H). The prevalence and incidence of chronic complications including chronic kidney disease, nephrolithiasis/nephrocalcinosis, hypertension, dyslipidemia, diabetes, cardiovascular disease, central nervous system disease, mental health disorders, eye disorders, bone mineral density alterations, fracture and cancer were evaluated. Patient data were compared with a group of patients who did not develop hypoparathyroidism, matched by gender, age, and follow-up time after thyroidectomy (group NH).ResultsWe included 337 patients in group H (median [IQR] age, 45 [36-56] years; median time of follow-up, 8.9 [6.0-13.0] years; women, 84.3%) and 669 in group NH (median age, 47 [37-55] years; median time of follow-up, 8.0 [5.3-12.0] years; women, 84.9%). No significant differences were found in the prevalence of comorbidities at the time of thyroidectomy between both groups. In multivariable adjusted analysis, patients with chronic hypoparathyroidism had significantly higher risk of incident chronic kidney disease (OR, 3.45; 95% CI, 1.72-6.91; P<0.001), nephrolithiasis (OR, 3.34; 95% CI, 1.55-7.22; P=0.002), and cardiovascular disease (OR, 2.03; 95% CI, 1.14-3.60; P=0.016), compared with patients without hypoparathyroidism. On the contrary, the risk of fracture was decreased in patients with hypoparathyroidism (OR, 0.09; 95% CI, 0.01-0.70; P=0.021).ConclusionThis study demonstrates that, in the clinical practice of Spanish endocrinologists, a significant increase in the risk of chronic kidney disease, nephrolithiasis and cardiovascular disease, as well as a reduction in the risk of fractures is detected. These results are of interest for the development of new clinical guidelines and monitoring protocols for patients with hypoparathyroidism.

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Section: Discussionmentioning

confidence: 99%

“…The group NH consisted of 669 patients (568 women, 84.9%) aged between 18 and 79 years (median 47 [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] years). Demographic and clinical characteristics are shown in Table 1.…”

Section: Studied Patientsmentioning

confidence: 99%

Incident comorbidities in patients with chronic hypoparathyroidism after thyroidectomy: a multicenter nationwide study

Díez,

Anda,

Pérez-Corral

et al. 2024

Front. Endocrinol.

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“…Interestingly, VD deficiency was invariably found in patients with active disease who showed lower V25OH-D levels vs control individuals with a significantly positive correlation between IGF-I and V25OH-D levels in active patients ( 33 ). Other reports have suggested that free VD is decreased in acromegaly and that tt (TaqI), aa (ApaI), and bb (BsmI) polymorphisms of the VDR gene may be associated with better bone quality and microarchitecture (higher trabecular bone score), which lead to a lower risk of osteoporotic fractures in acromegaly patients ( 34 , 35 ). A possible role for lipophilic substance malabsorption by SSA in determining low VD levels was hypothesized ( 36 ) but not confirmed by more recent studies ( 37 , 38 ).…”

Section: Discussionmentioning

confidence: 99%

Cholecalciferol Use Is Associated With a Decreased Risk of Incident Morphometric Vertebral Fractures in Acromegaly

Chiloiro,

Frara,

Gagliardi

et al. 2023

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Skeletal fragility is observed in 30% to 60% of acromegaly patients, representing an emerging complication of the disease that increases disability. Despite several studies having investigated the clinical and hormonal prognostic factors for the occurrence of vertebral fractures (VFs) in acromegaly, very few data are available on their prevention/treatment including the effect of vitamin D (VD) supplementation, which has been reported to have a fracture-protective effect in several studies in patients with osteoporosis. Objective We aimed to investigate the role of cholecalciferol (D3) supplementation in the prevention of incident VFs (i-VFs) in acromegaly. Methods A longitudinal, retrospective and multicenter study was performed on 61 acromegaly patients treated and untreated with D3 supplementation. Results Twenty-six patients were treated with D3 supplementation according to clinical guidelines. The median D3 weekly dosage was 8500 IU (interquartile range [IQR]: 3900). The median duration of D3 supplementation was 94 months (IQR: 38). At last follow-up, i-VFs were diagnosed in 14 patients (23%). I-VFs were less prevalent in patients on D3 supplementation (14.3% of cases) compared to patients not treated with D3 (85.7%; P = .02). The final level of serum V25OH-D was significantly lower in patients who developed i-VFs (28.6 ng/mL, IQR: 4.1) compared to patients who did not develop i-VFs (34.2 ng/mL, IQR: 9.6; P = .05). The logistic regression confirmed the protective role of D3 supplementation on the occurrence of i-VFs (odds ratio: 0.16; 95% CI, 0.03-0.79; P = .01). Conclusion It is likely that D3 supplementation could lead to a reduction in i-VFs in acromegaly.

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“…The current thinking attributes this discrepancy to a prevalent impact of pituitary and other hormone hyperproduction on bone quality with respect to bone quantity [ 36 ]. Therefore, new tools such as vertebral morphometry for detecting subclinical or previously undiagnosed vertebral fractures (VFs) and methods for assessing bone quality have become fundamental in the modern approach to bone comorbidities in patients with pituitary adenomas, as in those with acromegaly [ 37 ]. These methods are briefly reviewed below.…”

Section: Methods For the Evaluation Of Bone Healthmentioning

confidence: 99%

“…Briefly, bone quality in acromegaly has been assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT), a three-dimensional noninvasive imaging technique that scans the extremities and can assess volumetric bone density and microarchitecture of cortical and cancellous bone [ 46 ]. HR-pQCT is still mostly used for research because it is expensive and not widely available [ 37 ]. Interesting results have also been obtained with high-resolution cone-beam computed tomography, which rapidly scans the extremities with a larger field of view but reduced image contrast because of artifacts, as compared to HR-pQCT [ 47 ].…”

Section: Methods For the Evaluation Of Bone Healthmentioning

confidence: 99%

Acromegaly and Bone: An Update

Giustina

2023

Endocrinol Metab

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Since our discovery in 2006 that acromegaly is associated with an increased risk of vertebral fractures, many authors have confirmed this finding in both cross-sectional and prospective studies. Due to the high epidemiological and clinical impact of this newly discovered comorbidity of acromegaly, this topic has progressively become more important and prominent over the years, and the pertinent literature has been enriched by new findings on the pathophysiology and treatment. The aim of this narrative review was to discuss these novel findings, integrating them with the seminal observations, in order to give the reader an updated view of how the field of acromegaly and bone is developing, from strong clinical observations to a mechanistic understanding and possible prevention and treatment.

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New tools for bone health assessment in secreting pituitary adenomas

Cited by 9 publications

References 77 publications

Incident comorbidities in patients with chronic hypoparathyroidism after thyroidectomy: a multicenter nationwide study

Incident comorbidities in patients with chronic hypoparathyroidism after thyroidectomy: a multicenter nationwide study

Cholecalciferol Use Is Associated With a Decreased Risk of Incident Morphometric Vertebral Fractures in Acromegaly

Acromegaly and Bone: An Update

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