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Medline ® Abstract for Reference 47

of 'Rheumatic and bone disorders associated with acromegaly'

Vertebral fractures in patients with acromegaly: a 3-year prospective study.
Mazziotti G, Bianchi A, Porcelli T, Mormando M, Maffezzoni F, Cristiano A, Giampietro A, De Marinis L, Giustina A
J Clin Endocrinol Metab. 2013 Aug;98(8):3402-10. Epub 2013 Jun 14.
CONTEXT: Cross-sectional studies showed an elevated prevalence of vertebral fractures in acromegaly. However, no data are available on incident vertebral fractures in this clinical setting.
OBJECTIVE: The objective of the study was to investigate the incidence and risk factors of vertebral fractures in patients with acromegaly.
DESIGN: This was a 3-year prospective study.
SETTING: The study was conducted at referral centers.
SUBJECTS: Eighty-eight patients with acromegaly (33 females, 55 males; mean age 50 years, range 21-85 years) and 106 control subjects, matched for sex and age (43 females and 63 males, mean age 55 years, range 33-79 years), attending outpatient bone clinics participated in the study.
MAIN MEASURES: Patients and control subjects were evaluated for the incidence of vertebral fractures using a quantitative morphometric approach on spine x-ray, which was performed at baseline and after 3 years of follow-up. At the same time points, patients with acromegaly were also evaluated for bone mineral density with dual-energy X-ray absorptiometry at lumbar spine and femoral neck.
RESULTS: After a 3-year follow-up, 37 patients with acromegaly (42.0%) and 4 control subjects (3.8%) experienced incident vertebral fractures (P<.001). The incidence of vertebral fractures was significantly higher in patients with active disease as compared with those who had controlled/cured acromegaly at the study entry (62.5% vs 25.0%; P<.001). The risk of incident vertebral fractures was significantly associated with hypogonadism, a change in the femoral neck bone mineral density, and prevalent vertebral fractures at the study entry only in patients with controlled/cured acromegaly, whereas in patients with active disease, the fracture risk was not influenced by the above-mentioned clinical factors, but it was significantly associated with the duration of active acromegaly.
CONCLUSIONS: This prospective study demonstrates a high rate of incident vertebral fractures both in patients with active and controlled acromegaly.
Chair of Endocrinology, University of Brescia, Endocrine Service, Spedali Civili, 25125 Brescia, Italy.