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Endocrine Abstracts (2016) 41 EP928 | DOI: 10.1530/endoabs.41.EP928


1Pituitary Unit, Departments of Endocrinology, Catholic University School of Medicine, Rome, Italy; 2Barts and The London School of Medicine, London, UK.

Aim: To evaluate calcium and bone metabolism in a monocentric series of acromegaly patients (pts), treated with pegvisomant (PEG) alone or in association to long acting somatostatine analogs.

Patients and methods: All pts with at least 24 consecutive months PEG treatment (alone or in combination with SSA) were enrolled. All pts had been tested at least twice/year for biochemical acromegaly-disease evaluation and annually for calcium metabolism and for bone metabolism though serum test. In all the cases, BMD of femoral neck and lumbar spine was measured by DXA. Measurements were made at the time of the spinal X-ray. Fractured vertebrae (VF), were excluded from the lumbar BMD analysis. A quantitative morphometrical assessment of VFs in the T4–L4 region had been performed using a dedicated morphometrical software (Spine-X Analyzer, ICAM Diagnostics, Milan, Italy).

Results: A total of 24 pts met the inclusion criteria. 8 were male (33.3%). Mean age at acromegaly diagnosis was 39.3 years. 11 pts had a biochemically controlled acromegaly (45.8%). PEG treatment was prescribed in 5 cases as monotherapy. A total of 16 VFs were documented and occurred in 8 pts. Mean spine BMD was 1.09 and mean femoral BMD was 0.9. VF, spine and femoral BMD are not influenced in our series from gender, GH receptor isoform expression, secondary hypogonadism, menopause, bone metabolism markers and hormonal replacement treatment for hypogonadism, hypoadrenalism and hypothyroidism. We found that biochemically acromegaly status strongly correlated with VF: a higher number of VF were observed in not biochemically controlled acromegaly pts. Moreover, active acromegaly status correlated with a 10-folds higher risk of VF (P=0.012, OR: 10.12 95%IC 1.47–69.9). Moreover, in male acromegalic pt, VF correlated also with lower serum testosterone (P=0.02) and SHBG value (P<0.001). In female acromegaly pts we failed to find any correlation between gonadic status and VF. In conclusion, our study confirm the risk of VFs in acromegaly and suggest that fracture risk is higher in not biochemically controlled acromegaly pts, particularly in males with low testosterone value.

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