The role of advanced glycation end products on vertebral fractures in patients with acromegaly

Uygur Meliha Melin; Yazıcı Dilek Dereli; Yavuz Dilek Gogas

doi:10.1530/endoabs.81.P145

Introduction: Acromegalic osteopathy is an emerging complication characterized by high risk for vertebral fractures (VFS), whereas bone mineral density (BMD) may not be useful to predict the risk. Recent studies have reported that increased advenced glycation end products (AGEs) are associated with bone fragility. We aimed to evaluate the relationship between AGEs and VFs in patients with acromegaly.

Study design: Cross-sectional

Patients & MethodsWe enrolled 70 subjects from the Department of Endocrinology and Metabolism Disease, Marmara University Medical School in acromegaly group (AG) and compared with 70 healthy controls (HC) without any risk factors for secondary osteoporosis and pituitary disorder. We performed vertebral morphometric evaluation of the lateral thoracic and lumbar spine X-ray images, and collected demographic, biochemical, clinical data. AGEs were measured by the auto-fluorescence (AF) reader.

Results: The prevalence of VFs was significantly higher despite elevated BMD in AG than HC (32.9% vs. 8.6%; P<0.001). Controlled/cured acromegaly had higher VFs prevalence than active acromegaly (12.5% vs. 38.9%, P=0.06). AG had significantly higher levels of AGEs, HbA1c and CTx than HC (P=0.04, P=0.01, P=0.001; respectively). There was a negative correlation between AGEs and CTx in AG (r=-0.371, P=0.001). In multivariate logistic regression analysis (Table-1), disease duration, IGF-1 levels were negatively correlated with VFs, whereas AF was positively related to the VFs (R²=19.23, P=0.02) in the AG.

Table 1
	OR	95% CL	P value
Age	0.995	0.943-1.1051	0.86
Disease duration	0.790	0.664-0.940	0.008
Insulin-Like Growth Factor-1	0.991	0.985-0.998	0.012
Fasting Plasma Glucose	1.036	0.958-1.119	0.37
I.nsulin	1.217	0.610-2.430	0.57
HOMA-IR	0.502	0.034-7.395	0.61
Auto-Fluorescence	15.535	1.442-167.329	0.024
B-Cross Laps	5.609	0.339-92.944	0.22
Osteocalcin	0.993	0.930-1.059	0.82

Conclusion: VFs might occur independently from the disease activity and duration and be an early complication of the acromegaly. AGEs may be useful for assessing the risk of prevalent VFs in this clinical setting.

References: 1. Mazziotti G et al. Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2015;100(2):384-94.

2. Yamamoto. “Serum Pentosidine Levels Are Positively Associated with the Presence of Vertebral Fractures in Postmenopausal Women with Type 2 Diabetes.” The journal of clinical endocrinology & metabolism. 93.3 (2008): 1013–1019

3. Yamamoto. “Low Serum Level of the Endogenous Secretory Receptor for Advanced Glycation End Products (esRAGE) Is a Risk Factor for Prevalent Vertebral Fractures Independent of Bone Mineral Density in Patients with Type 2 Diabetes.” Diabetes care. 32.12 (2009): 2263–2268.

Endocrine Abstracts

P145