Progression of vertebral fractures in long-term controlled acromegaly: a 9-year follow-up study

Abstract

Objective Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess results in both reversible and irreversible musculoskeletal damage, including increased vertebral fracture (VF) risk. The prevalence of VFs is approximately 60% in controlled acromegaly patients, and these VFs can progress in time. We aimed to identify the course of VFs in a cohort of acromegaly patients in long-term remission and their associated risk factors during prolonged follow-up. Methods Thirty-one patients with acromegaly (49% female, median age 60 years (IQR 53–66)), who were in remission for 2 years, were included in this longitudinal, prospective, follow-up study. Spine radiographs of vertebrae Th4 to L4 were assessed for VFs using the Genant score, at baseline, after 2.6 years and 9.1 years. Progression was defined as either a new fracture, or a 1-point increase in Genant score. Results The prevalence of VF at baseline was 87% (27/31 patients). Progression of VFs was observed in eleven patients (35.5%) during the 9.1-year follow-up period, with a total incidence rate of 65.5 per 1,000 PY (Males 59.8 per 1,000 PY vs. females 71.6 per 1,000 PY). Patients treated with surgery or radiotherapy had a higher risk of VF progression in this cohort (P=0.030). Conclusions In this cohort of long-term well-controlled acromegalic patients, the prevalence and progression of VFs was high, showing that the deleterious effects of GH and IGF-1 excess on bone persist despite achievement of longstanding remission.

A Pituitary Society update to acromegaly management guidelines

“…However, patients with controlled acromegaly can continue to develop VFs. In a 9.1-year prospective follow-up study [29], VFs progressed in 11/31 (35.5%), with patients post-surgery or post-radiation demonstrating a higher risk of VF progression (p = 0.030).…”

Prevalence of vertebral fractures and serum sclerostin levels in acromegaly

“…A study showed signi cantly higher serum sclerostin levels in active acromegaly patients compared to controls and sclerostin levels correlated with the GH and IGF-1; nevertheless, VFs and bone turnover markers were not evaluated (22). Other limitation is that the study involved only active acromegaly patients although increased prevalence and incidence of fractures in biochemically controlled acromegaly patients was shown in previous studies (9,12,14). İn another study which included active and controlled acromegaly patients, patients with acromegaly had signi cantly lower sclerostin levels than the control group (23).…”

“…Hypogonadism is found to be associated with VFs towards acromegaly patients in several studies (7)(8)(9). However, the data were con icted considering the association between hypogonadism and VFs, since no relation was shown in a recent study (14).…”

Towards an Earlier Diagnosis of Acromegaly and Gigantism

“…Moreover, in the studied cohorts of long-term, well-controlled acromegalic patients, the prevalence and progression of VFs was high, showing that the deleterious effects of GH and IGF-1 excess on bone persist despite achievement of longstanding remission. [3][4][5].…”