Affiliation:
1. 1Neuroendocrine Unit
2. 2Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
3. 3Department of Orthopedic Surgery and Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Abstract
Context
Both acromegaly and adult growth hormone deficiency (GHD) are associated with increased fracture risk. Sufficient data are lacking regarding cortical bone microarchitecture and bone strength, as assessed by microfinite element analysis (µFEA).
Objective
To elucidate both cortical and trabecular bone microarchitecture and estimated bone strength in men with active acromegaly or GHD compared to healthy controls.
Design and subjects
Cross-sectional study at a clinical research center, including 48 men (16 with acromegaly, 16 with GHD and 16 healthy controls).
Outcome measures
Areal bone mineral density (aBMD), cortical and trabecular bone microarchitecture and estimated bone strength (µFEA) at the radius and tibia.
Results
aBMD was not different between the 3 groups at any skeletal site. At the radius, patients with acromegaly had greater cortical area (P < 0.0001), cortical thickness (P = 0.0038), cortical pore volume (P < 0.0001) and cortical porosity (P = 0.0008), but lower trabecular bone density (P = 0.0010) compared to controls. At the tibia, patients with acromegaly had lower trabecular bone density (P = 0.0082), but no differences in cortical bone microstructure. Compressive strength and failure load did not significantly differ between groups. These findings persisted after excluding patients with hypogonadism. Bone microarchitecture was not deficient in patients with GHD.
Conclusions
Both cortical and trabecular microarchitecture are altered in men with acromegaly. Our data indicate that GH excess is associated with distinct effects in cortical vs trabecular bone compartments. Our observations also affirm the limitations of aBMD testing in the evaluation of patients with acromegaly.
Subject
Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism
Reference56 articles.
1. Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women;Journal of Bone and Mineral Research,2008
2. Bone mineral density in patients with growth hormone deficiency: does a gender difference exist?;Clinical Endocrinology,2006
3. Menstrual irregularity in women with acromegaly;Journal of Clinical Endocrinology and Metabolism,1999
4. The effect of somatostatin analogs on vitamin D and calcium concentrations in patients with acromegaly;Pituitary,2014
5. Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis;Journal of Clinical Endocrinology and Metabolism,2015
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