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

I C M Pelsma,M Kloppenburg,N R Biermasz,H M Kroon,W R Van Furth,K M J A Claessen,N M Appelman-Dijkstra,A M Pereira

doi:10.1530/eje-20-0415

I C M Pelsma, M Kloppenburg + Show 6 more

Open Access

https://doi.org/10.1530/eje-20-0415

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Abstract

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. 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. 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 1000 person years (males 59.8 per 1000 person years vs females 71.6 per 1000 person years). Patients treated with surgery or radiotherapy had a higher risk of VF progression in this cohort (P = 0.030). 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.

Highlights

Is a rare, chronic, and progressive endocrine disorder caused by a growth hormone (GH)-producing pituitary adenoma, resulting in elevated serum GH and insulin-like growth factor-1 (IGF-1) levels [1], which requires a multimodal, individualized treatment approach
New vertebral fractures (VF) were described in 35% of medically treated patients during a follow-up period of 6.8 years [17]. In this long-term, follow-up study, we aimed to evaluate the course of VFs during a prolonged follow-up period of 9 years in a cohort of long-term, well-controlled acromegaly patients, focusing on the identification of risk factors for VF progression
VF progression was not related to pre-treatment IGF-1 levels, active disease or remission duration, hypogonadism, and Spinal deformity index (SDI) at baseline

Summary

Introduction

Is a rare, chronic, and progressive endocrine disorder caused by a growth hormone (GH)-producing pituitary adenoma, resulting in elevated serum GH and insulin-like growth factor-1 (IGF-1) levels [1], which requires a multimodal, individualized treatment approach. While reversal of GH excess ameliorates most symptoms and mortality risk, the skeletal complications, for example, vertebral fractures (VF) and arthropathy, persist or even progress [6]. The altered bone microarchitecture, resulting in cortical bone thickening and loss of trabecular volume, contributes to the increased fracture risk [8, 9, 10]. These alterations persist after biochemical remission [8]. The increased skeletal fragility is reflected by a high VF prevalence, up to 60%, both after long-term disease control and irrespective of BMD levels [7]. Risk factors for VFs are male sex, active disease duration and untreated hypogonadism [11, 12, 13, 14]

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