Endocrine Abstracts

JOINT1616

Objective: Acromegaly is associated with multiple musculoskeletal complications that affect quality of life and work ability. No nationwide studies on these debilitating complications exist. We aimed to examine the risk of osteoarthritis, musculoskeletal surgery (incl. JOINT replacement), osteoporosis, fractures, and analgesic consumption in a national cohort of acromegaly patients.

Design: National, registry-based cohort study.

Methods: All validated incident and prevalent cases of acromegaly in the period 1977-2021 (n = 844) were included and matched 1:100 with healthy controls on sex and birth year. Outcomes were retrieved from the Danish Healthcare registries and identified using diagnosis, surgical procedure and medication codes. Time-to-event analyses in the form of Cox regression and Kaplan-Meier plots were applied.

Results: Patients were at significantly increased risk of osteoarthritis of the shoulder (HR: 5.25 [3.05; 9.06]), hip (HR: 3.15 [2.57; 3.87]) and knee (HR: 2.25 [1.85; 2.72]), and osteoporosis (HR: 2.13 [1.64; 2.78]) even before the acromegaly diagnosis. The risk of JOINT replacement surgery of the shoulder (HR: 4.60 [2.57; 8.25]), hip (HR: 3.32 [2.67; 4.12]) and knee (HR: 2.52 [1.89; 3.36]) was increased in acromegaly patients, as was the risk of being prescribed weak analgesics (HR: 1.22 [1.04; 1.44]) or opioids (HR: 1.58 [1.38; 1.82]). Furthermore, patients had a higher risk of being diagnosed with degenerative spinal disorders, such as spondylosis (HR: 2.04 [1.50; 2.77]), spinal stenosis (HR: 2.12 [1.56; 2.88]) and intervertebral disc herniation (HR: 1.79 [1.21; 2.66]). Surgical complications (HR: 2.19 [1.59; 3.03]) and repeat hip surgery (HR: 3.64 [2.09; 6.34]) also exhibited increased risk in patients.

Conclusion: In acromegaly, severe osteoarthritis involving multiple JOINTs develops even before acromegaly diagnosis and continues to progress over time, despite acromegaly-specific treatment and biochemical disease control. Furthermore, acromegaly imposes an increased risk of osteoporosis, musculoskeletal surgery - particularly JOINT replacement surgery -, surgical complications and necessity of strong analgesic medication. Our findings warrant further research into the management of musculoskeletal disease in acromegaly.