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Endocrine Abstracts (2015) 37 GP19.02 | DOI: 10.1530/endoabs.37.GP.19.02

1Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 2Endocrinology and Diabetology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 3Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.

Introduction: Acromegaly is characterised by chronic exposure to high GH and IGF1 levels that leads to increased bone turnover. Regardless of BMD value, acromegalic patients seem to have an increased vertebral fracture risk probably due to a reduction of bone quality. Trabecular bone score (TBS) is a new index used for assessing bone microarchitecture. In this study TBS was used for the first time to analyze bone quality in acromegaly.

Methods: 16 new acromegalic patients (12F, age 56.3±13.8, BMI 28.1±6.3) and 16 controls matched for age, gender, menopausal state, and BMI were enrolled. Patients with MEN1, ectopic GHRH secretion, and history of secondary osteoporosis were excluded. All participants underwent lumbar radiograph and dualenergy X-ray absorptiometry scan on lumbar spine (LS) and femur (total:FT and neck:FN). TBS was assessed in the region of LS-BMD.

Results: 56% of patients had a macroadenoma, 18% had hypopituitarism (all hypoadrenalism), and nobody had cosecretion. BMDs were not different between the two groups (acromegalic patients vs controls: LS T-score −0.5±1.3 vs −0.7±1.0, P=0.7 and LS Z-score 0.5±1.3 vs 0.5±1.5, P=0.7; FN T-score −0.6±0.9 vs −0.7±1.2, P=0.8 and FN Z-score 0.3±0.7 vs 0.2±0.8, P=0.4; FT T-score 0.02±1.01 vs −0.5±0.99, P=0.2 and FT Z-score 0.64±0.84 vs 0.4±0.8, P=0.4) while acromegalic patients had lower TBS than controls (TBS Z-score −2.27±2.05 vs −1.00±0.9, P=0.04 and TBS value 1.195±0.14 vs 0.8±0.6, P=0.01). Two patients and one control had vertebral fractures (P=1.0). In acromegalic patients, at bivariate analysis TBS was associated with age at diagnosis (r2: −0.25, P=0.04), GH serum levels (r2: 0.36, P=0.01), FN T-score (r2: 0.35, P=0.02), and Z-score (r2: 0.81, P=0.01). Vertebral fractures were associated with age at diagnosis (r2: 0.36, P=0.02). LS-BMD and FT-BMD were related to alteration of glucose metabolism (r2: 0.25, P=0.04 and r2: 0.49, P=0.002 respectively).

Conclusions: Acromegalic patients had impaired bone quality despite normal bone density. Further larger studies are needed to define TBS role in fracture risk in acromegaly.

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