Non-invasive DXA-derived bone structure assessment of acromegaly patients: a cross-sectional study

Kužma, Martin; Vaňuga, Peter; Ságová, Ivana; Pávai, Dušan; Jackuliak, Peter; Killinger, Zdenko; Binkley, Neil; Winzenrieth, Renaud; Genant, Harry K.; Payer, Juraj

doi:10.1530/eje-18-0881

Cited by 51 publications

(52 citation statements)

References 32 publications

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“…Our findings of increased femoral hip dimension and cortical thickness in patients with active acromegaly compared with NFPA support previous cross‐sectional studies using different methods for cortical bone assessment, and are in line with a specific effect of GH excess on bone geometry and cortical architecture . As expected, weight correlated with cortical thickness in both groups and measured sites, except for the femoral neck in acromegaly.…”

Section: Discussionsupporting

confidence: 91%

“…Bone turnover is increased in acromegaly; accordingly, cortical porosity has been found increased in patients with active disease and vertebral fractures, partly explaining the discrepancy between bone mass and strength. An association between cortical thickness in the hip and vertebral fractures was recently demonstrated . Future studies should evaluate the association between cortical thickness in the proximal femur and nonvertebral fractures in acromegaly.…”

Section: Discussionmentioning

confidence: 92%

“…An association between cortical thickness in the hip and vertebral fractures was recently demonstrated. (34) Future studies should evaluate the association between cortical thickness in the proximal femur and nonvertebral fractures in acromegaly.…”

Section: Discussionmentioning

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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 92%

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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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“…However, subsequent work demonstrated abnormalities in trabecular bone microstructure and strength in active acromegalic patientseven when gonadal function was normal (84,85,86). In addition to these changes in cancellous bone, the cortical bone compartment is affected, and GH excess is associated with increased cortical porosity/pore volume (81,84,87) and decreased cortical density (85).…”

Section: Effects Of Gh Excess On Bone Histomorphometry and Architecturementioning

confidence: 99%

“…VFs are not a simple radiological finding but they should be considered a marker of skeletal fragility, since an association between fractures and abnormalities in bone microstructure was found following the analysis of bone samples from individuals with acromegaly by histomorphometry, tridimensional dual-energy X-ray absorptiometry (DXA) of the proximal femur and peripheral HR-QCT of the bone structure at the distal radius (81,85,87).…”

Section: Effects Of Gh Excess On Fracture Riskmentioning

confidence: 99%

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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Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging

et al. 2023

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Purpose Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. Summary This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice. Supplementary Information ...

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Non-invasive DXA-derived bone structure assessment of acromegaly patients: a cross-sectional study

Cited by 51 publications

References 32 publications

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

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

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

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