Context: Previous studies suggest that patients with acromegaly were at higher risk of vertebral fractures (VFs) despite normal bone mineral density (BMD). However, these patients could have several associated endocrine deficits known to increase the fracture risk, such as hypogonadism. In addition, patients with acromegaly have radiological deformations of the spine, called Erdheims syndrome, which can overestimate the radiological VFs.
Objective: Investigate the prevalence of VFs in a cohort of patients with acromegaly.
Methods: It was a monocentric, retrospective and prospective study. Patients with acromegaly under 80 years of age and followed at the Nantes University hospital in January 2018 were included. Patients were excluded if they had a rheumatologic or endocrine disease interfering with the results. The rheumatologic evaluation was less than 3 years for all patients. The prevalence of radiological VFs was evaluated on conventional lombar and thoracic spine radiographs using Genants semi quantitative assessment. We studied qualitative abnormalities of the spine using three criteria: osteophytes, disc space narrowing and cuneiform aspect of vertebrae. The X-rays were read by two rheumatologists independently. We analyzed BMD at lumbar spine and total hip, endocrine status and quality of life was investigated by three questionnaires (AcroQol, specific of acromegaly; Oswestry evaluating the functional impact of pain; HAQ evaluating the functional capacity).
Results: Fifty patients (19 females, 31 males) with a median age of 53 (range 2879) were included. The average of time between the diagnosis of acromegaly and the last rheumatologic evaluation was 9.1 years. Three patients (6.1%) had a VF: 1 grade 1 and 2 grade 2 of Genants assessment. 28% patients were osteopenic and 12% were osteoporotic. 26% were hypogonadal (100% substituted), 16% had central adrenal insufficiency (100% substituted). 14 women were menopaused (74% of women). Thoracic spine was deformed in 31 patients (61%) and lombar spine in 21 patients (43%). Patients with spine deformation were older (P=0.043), with higher BMI (P=0.004) and had a trend to be more hypogonadal (P=0.06). Concerning quality of life, AcroQoLs average was 70.9% (score 0 to 100, maximal quality of life =100, range 3298), HAQs average was 0.18 (score 0 to 3, maximal quality of life 0, range 01.38) and Oswestrys average was 9.8 (score 0 to 100, maximal quality of life 0, range 044).
Conclusions: Acromegaly patients are not at an increased risk of vertebral fractures, but they have vertebral deformations.
18 - 21 May 2019
European Society of Endocrinology