Italy: The researchers in a recent study, have reported for the first time a high prevalence of radiological vertebral fractures (VFs) in patients with a recent acromegaly diagnosis. The findings led to the hypothesis that VFs are an early phenomenon of acromegaly and are related to the levels of growth hormone (GH). The study appears in The Journal of Clinical Endocrinology & Metabolism.
In acromegaly, osteopathy and morphometric vertebral fractures are known to be emerging complications. However, VFs prediction in this clinical setting is still uncertain, and it is debatable if they are an early event in the natural history of the disease. Andrea Giustina, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy, and colleagues, therefore, aimed to evaluate the prevalence and determinants of morphometric VFs in patients with recently diagnosed acromegaly.
For this purpose, the researchers enrolled 92 patients (43M/49F) at admission in the Neurosurgery Unit before transsphenoidal surgery. They were compared with control subjects without secondary osteoporosis, and pituitary disorder. A VF assessment was performed on pre-operative chest X-ray (MTRx) images and biochemical, demographic, and clinical data were collected.
The findings of the study were as follows:
A significantly higher prevalence of VFs (33.7%) was detected in patients with acromegaly than in the controls.
Among the patients with acromegaly and VFs, 12 (38.7%) showed multiple VFs, and 5 (16.1%) showed moderate/severe VFs.
Patients with VFs had higher random serum GH levels than those with no VFs, but there was no difference in IGF-I and IGF-I ratio.
Free T3 was slightly lower in patients with acromegaly and VFs than in those without VFs.
In multiple logistic analyses, GH was independently associated with the risk for VFs.
The preoperative serum GH cut-off value that predicted VFs was 12ng/mL.
The researchers reported a high prevalence of radiological VFs in patients with recent diagnosis of acromegaly for the first time. "Therefore, we can hypothesize that VFs is an early phenomenon of acromegaly and related to GH levels," the authors wrote. This implies that VF assessment should be included in the work-up at the acromegaly diagnosis.
Reference:
Stefano Frara, Meliha Melin Uygur, Luigi di Filippo, Mauro Doga, Marco Losa, Simona Santoro, Pietro Mortini, Andrea Giustina, High Prevalence of Vertebral Fractures Associated with Preoperative GH Levels in Patients with recent Diagnosis of Acromegaly, The Journal of Clinical Endocrinology & Metabolism, 2022;, dgac183, https://doi.org/10.1210/clinem/dgac183