Objectives: The primary objective was to study the prevalence and the risk factors of vertebral fractures (VFs) in acromegaly patients either at diagnosis of acromegaly or during the follow-up. The role of routine chest radiography for detecting VFs in acromegaly was also evaluated.
Design and methods: A retrospective cohort study was performed on 60 consecutive acromegaly patients, in a tertiary referral center. The presence of VFs was firstly evaluated in each patient on lateral radiograph of the thoracolumbar spine (X-spine) performed at the last clinical visit during the follow-up. Secondly, routine chest X-rays (X-chest) performed at the time of diagnosis of acromegaly because part of the general evaluation at admission, were retrospectively reviewed for detecting VFs and compared to X-spine. Data were evaluated using binary logistic regression.
Results: Overall, 27 (45%) out of 60 patients had VFs at X-spine. Among those patients 37% had fractured vertebrae at the time of the diagnosis of acromegaly, although undiagnosed. Patients with VFs at baseline had higher IGF-1 index compared to those who had fractures after the diagnosis of acromegaly (P=0.043). The comparison between the X-spine and the X-chest revealed an incidence of new VFs in 40% of patients, after diagnosis of acromegaly. The determinants of VFs were age (HR 1.05, P=0.038) and hypogonadism (HR 6.14, P=0.025). Conversely, therapy for acromegaly or bone mineral density values did not influence the outcome.
Conclusion: Nearly 40% of patients, who suffer from VFs, had fractured vertebrae undiagnosed on chest radiography at time of diagnosis of acromegaly. At baseline, VFs might correlate to the severity of acromegaly. After diagnosis of acromegaly, patients are at high risk of developing new fractures especially when hypogonadism is associated. On routine chest radiography, acromegaly patients should be also evaluated for the presence of VFs.
21 May 2022 - 24 May 2022