SUN-382 Craniopharyngioma Patients Are at Risk of Impaired Bone Health

Abstract

IntroductionCraniopharyngioma (CP) are benign tumors originating from the sellar/hypothalamic region that are associated with neurological damage, epilepsy and endocrinopathies, which all could negatively affect bone health. Our objective was to determine fracture risk, bone mineral density (BMD) and final height in CP and evaluate independent determinants for fractures.MethodsIn this retrospective study, Dutch/Swedish patients with CP were included if data was available on fractures, bone mineral density (BMD) (T/Z-score), or final height (age >18 years). Data is presented as mean±SD unless stated otherwise. Logistic regression models were developed to evaluate determinants for fractures and osteoporosis. Low BMD was defined as T- or Z-score ≤-1 and osteoporosis as ≤-2.5 or ≤-2.0, respectively.ResultsWe included 177 patients (48% female, 48% childhood-onset disease), with a median age at last follow-up of 45 years (range 15-92 years). Fractures occurred in 31 patients (18%); a fracture rate of 5.8 per 1000 person years. Eight patients suffered from multiple fractures (26%). In a multivariable logistic regression model for fractures, significant protective factors were female sex (OR 0.3 P=0.004) and surgery (OR 0.1, P=0.009), whereas a risk factor was use of anti-epileptics (OR 3.0, P=0.07). A significant risk factor for osteoporosis was age (OR 1.03, P=0.03); growth hormone replacement therapy tended to be protective (OR 0.2, P=0.10). Osteoporosis was not an explanatory variable for fractures (OR 2.1, P=0.21). Mean BMD T- and Z-scores were normal: Z-scores for L2-L4, femur neck and total body were 0.0±2.0 (range -3.5 - 6.8), -0.1±1.3 (range -2.7 - 4.7) and 0.1±1.5 (range -4.1 - 3.5), respectively. Osteoporosis occurred in 22 patients (24%); mean age of patients with osteoporosis was 53 ± 20 years. Low BMD occurred in 47 patients (50%). Medication to improve BMD was less often used in men than in women(7% vs. 18%, P=0.02). Mean final height was normal and did not differ between males/females, or adulthood/childhood-onset patients.ConclusionsPatients with CP have a high fracture rate. In this population, epilepsy treatment was a risk factor, female sex a protective factor whereas osteoporosis did not affect the risk for fractures. Mean BMD Z-score was normal, but with a very wide range, resulting in low BMD in 50% and osteoporosis in 24% of the patients. Male CP patients are potentially undertreated with medication to improve bone health.