5th Department of Internal Medicine, Faculty of Medicine, Comenius University Bratislava, University Hospital Bratislava, Bratislava, Slovak Republic.
Physiol Res. 2019 Nov 30;68(Suppl 2):S121-S129. doi: 10.33549/physiolres.934303.
This article is focused on endocrine-mediated osteoporosis caused by growth hormone (GH) disorders; adult GH deficiency and acromegaly. GH and insulin like growth factor-1 (IGF-1) stimulate linear bone growth through complex hormonal interactions and activates epiphyseal prechondrocytes. GH, via receptor activator of nuclear factor-kappaB (RANK), its ligand (RANK-L), and the osteoprotegerin system, stimulates production of osteoprotegerin and its accumulation in bone matrix. Malfunction of this mechanism, could lead to specific bone impairment. However, the primary problem of bone disease in GH secretion disorders is the primary prevention of osteoporotic fractures, so it is important to determine bone quality that better reflects the patient's actual predisposition to fracture. A method estimating bone quality from lumbar spine dual X-ray absorptiometry (DXA) scans is trabecular bone score (TBS). TBS in addition to bone mineral density (BMD) is a promising predictor of the osteoporotic fracture risk in women with postmenopausal osteopenia. In acromegaly TBS better defines risk of fracture because BMD is normal or even increased. TBS helps to monitor the effect of growth hormone therapy. Despite these findings, TBS should not be used alone, but a comprehensive consideration of all fracture risk factors, BMD and bone turnover markers is necessary.
本文重点介绍了由生长激素（GH）紊乱引起的内分泌介导性骨质疏松症；成人 GH 缺乏症和肢端肥大症。GH 和胰岛素样生长因子-1（IGF-1）通过复杂的激素相互作用刺激线性骨生长，并激活骺软骨前细胞。GH 通过核因子-κB 受体激活剂（RANK）、其配体（RANK-L）和骨保护素系统，刺激骨保护素的产生及其在骨基质中的积累。该机制的功能障碍可能导致特定的骨骼损伤。然而，GH 分泌紊乱导致的骨骼疾病的主要问题是预防骨质疏松性骨折，因此，确定更好地反映患者实际骨折易感性的骨骼质量非常重要。一种从腰椎双能 X 射线吸收法（DXA）扫描中估计骨骼质量的方法是小梁骨评分（TBS）。TBS 除了骨密度（BMD）之外，还是绝经后骨质疏松症女性骨质疏松性骨折风险的有前途的预测指标。在肢端肥大症中，TBS 更好地定义了骨折风险，因为 BMD 正常甚至增加。TBS 有助于监测生长激素治疗的效果。尽管有这些发现，但不应单独使用 TBS，而是需要综合考虑所有骨折风险因素、BMD 和骨转换标志物。
