Open AccessVertebral Fractures Occur Despite Control of Acromegaly and Are Predicted by Cortical Volumetric Bone Mineral Density
Author(s) -
Martin Kužma,
Peter Vaňuga,
Ivana Ságová,
Dušan Pávai,
Peter Jackuliak,
Zdenko Killinger,
Neil Binkley,
Renaud Winzenrieth,
Juraj Payer
Publication year - 2021
Publication title -
the journal of clinical endocrinology and metabolism/journal of clinical endocrinology and metabolism
Language(s) - English
Resource type - Journals
eISSN - 1945-7197
pISSN - 0021-972X
DOI - 10.1210/clinem/dgab259
Subject(s) - acromegaly , medicine , bone mineral , femoral neck , cortical bone , bone density , quantitative computed tomography , bone disease , endocrinology , osteoporosis , urology , anatomy , hormone , growth hormone
Context Recent studies suggest that cortical bone could also play a role in vertebral fracture (VF) development in acromegaly. Objective Evaluate the occurrence of VFs and their relationship to dual energy x-ray absorptiometry–derived bone parameters. Methods A single-center 2-year prospective study of acromegaly patients was conducted. Each subject had L1-4 spine, femoral neck and total hip (TH) areal BMD measured using DXA, and trabecular bone score (TBS) measurement performed. 3D Shaper™ was used to assess proximal femur trabecular and cortical volumetric (v)BMD, cortical surface (s)BMD, and cortical thickness (Cth). VF assessment was performed using the lateral spine imaging IVA™ mode with a Hologic Horizon® densitometer using a semiquantitative approach. Study outcomes were assessed at 2 time points: baseline and month 24. Results 70 acromegaly patients (34 M/36F; average 55.1 years) were studied, including 26 with active disease. In 13 patients, 9 with controlled disease, VF was observed. A decrease in TBS, sBMD, neck trabecular vBMD, TH, and neck cortical vBMD in VF compared with non-VF subjects was observed (P < .05). Multivariate analysis of fracture prediction showed TH cortical vBMD as the best fracture prediction parameter with area under the curve of 0.774. TBS was negatively associated with fasting plasma glucose and glycated hemoglobin (HBA1c) at each time point during the follow-up. Conclusion From the total number of 13 VF subjects, 9 were in the controlled disease group. The most sensitive and specific predictor of incident VF was TH cortical vBMD, suggesting that cortical bone is involved in fracture development.