The Nature of the Metabolic Bone Disorder in Acromegaly

Riggs, B. Lawrence; Randall, Raymond V.; Wahner, Heinz W.; Jowsey, Jenifer; Kelly, Patrick J.; Singh, Manmohan

doi:10.1210/jcem-34-6-911

Cited by 108 publications

(33 citation statements)

References 1 publication

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“…which reflects bone formation, was normal in our patients as previously reported [12]; however, the diagnostic value of total ALP activity measurements is lim ited in acromegalic patients, while a better discrimination may be obtained with the bone-specific isoenzyme which can be in- creased even when total ALP is normal [13].…”

Section: Discussionsupporting

confidence: 73%

Normal Calcitonin Secretion in Acromegaly

Tabolli¹,

Bigi²,

Valtorta³

et al. 1987

Horm Res

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Calcium and phosphate metabolism has been studied in eight patients with active acromegaly. Plasma calcium, phosphate, alkaline phosphatase, creatinine and parathyroid hormone levels were in the normal range in all patients, while urinary calcium excretion, calcium/creatinine ratio and hydroxyproline were higher than in controls (p < 0.01, p < 0.01, p < 0.02, respectively). Basal plasma calcitonin levels were in the normal range and stimulation with calcium (3 mg/kg body weight in 10 min) showed similar calcitonin responses in acromegalic and normal subjects. Our data show that in normocalcemic acromegaly with high bone turnover calcitonin secretion is not abnormal.

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Section: Discussionsupporting

confidence: 73%

Normal Calcitonin Secretion in Acromegaly

Tabolli¹,

Bigi²,

Valtorta³

et al. 1987

Horm Res

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“…It has previously been theorized that declining activity of the growth hormone/somatomedin axis might be one cause for loss of bone mass with age [30]. The present finding points to the opposite conclusion, namely, that this endocrine decline might in some elders protect bone mass, perhaps by removing the stimulus of growth hormone to bone résorption and remodeling [31][32][33][34].…”

contrasting

confidence: 44%

Fractures in the men of a Veterans Administration Nursing Home: relation to 1,25-dihydroxyvitamin D.

Rudman

Mattson

et al. 1989

Journal of the American College of Nutrition

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One hundred fifty-three men, age 48-96, 86% white, had resided in this Nursing Home for an average of 6.3 years (range 1.3-36) as of August 1984. At that time, we reviewed their medical charts to record the numbers and sites of fractures which had been diagnosed during the preceding 1 to 5 years of Nursing Home residence, the duration of this period depending on the duration of institutionalization. In addition, a clinical database was compiled comprising 70 attributes, including diagnoses, drugs, plasma (serum) chemistries, and measures of hematologic, nutritional, and functional status. Fractures during the studied period of Nursing Home residence had occurred in 24 of 153 men; six residents had experienced two or more fractures. Fracture rates in hip, spine, and wrist were 2564, 366, and 549 per 100,000 patient years, respectively. The total fracture rate, hip fracture rate, and limb fracture rate were five to 11 times higher than in the age-matched general population of white men in the United States; in Rochester, MN; in Dundee, England; in Oxford, England; or in Finland. Univariate statistical analysis showed that the rates for hip fracture or for fracture at any site were significantly associated with 13 attributes: directly with age, plasma somatomedin C, blood urea N, serum creatinine, serum uric acid, serum 25-hydroxyvitamin D (25-OH-D), degree of functional impairment, and chronic urinary tract infection, and inversely with serum 1,25-dihydroxyvitamin D [1,25-(OH)2-D], serum albumin, hematocrit, and hemoglobin. There was not a significant correlation with the number of falls/month which occurred during the 7 months after August 1984. After the effect of age was partialed out, somatomedin C, 25-OH-D, 1,25-(OH)2-D, and the diagnosis of urinary tract infection were still significantly related to the occurrence of fractures. The fact that Nursing Home fracture cases had significantly higher blood urea nitrogen and 25-OH-D, and significantly lower 1,25-(OH)2-D, than their non-fracture counterparts suggests that impaired renal production of the latter vitamin D metabolite contributed to the excessive rate of fractures.

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“…In this disorder, bone turnover is increased, as reflected by in- creased radiocalcium turnover, increased urinary hydroxyproline excretion, and quantitative histology (26,27). However, skeletal mass (as measured by TB-Ca) is not markedly increased except in those patients who develop hypersomatotropism prior to epiphyseal closure (26).…”

Section: Discussionmentioning

confidence: 99%

Effects of Growth Hormone in Osteoporosis

Aloia

Zanzi

Ellis

et al. 1976

The Journal of Clinical Endocrinology & Metabolism

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107

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The effect of chronic administration of growth hormone (GH) to osteoporotic patients was studied using the techniques of total body neutron activation analysis, whole body counting, calcium tracer kinetics, photon absorptiometry, quantitative microradiography, and urinary hydroxyproline. Two dosage schedules were utilized for six months each: 2 units daily and 0.2 w3/4 units of GH daily (where W represents body weight expressed in kg). The lower dosage (2 units) did not produce any appreciable change in the indices studied. Following the higher dose, no evidence of any anabolic effect was apparent in most patients (i.e., no increase in total body levels of Ca, Na, K, P, or Cl). Increases were noted in the urinary calcium excretion rate and in the urinary hydroxyproline excretion. Bone mineral content decreased. The bone biopsies displayed an increase in bone formation and resorption surfaces in response to treatment, but these changes were not statistically significant. It may be concluded that under the conditions of this study, GH administration did not result in an increment in skeletal mass. Several side effects that are characteristic of acromegaly were observed, including hyperglycemia, hypertension, arthralgia, and the carpal tunnel syndrome. Because of the lack of demonstrated benefit and the associated complications of therapy, GH administration does not appear to be of value in the treatment of osteoporosis.

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The Nature of the Metabolic Bone Disorder in Acromegaly

Cited by 108 publications

References 1 publication

Normal Calcitonin Secretion in Acromegaly

Normal Calcitonin Secretion in Acromegaly

Fractures in the men of a Veterans Administration Nursing Home: relation to 1,25-dihydroxyvitamin D.

Effects of Growth Hormone in Osteoporosis

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