Endocrinology, Diabetology and Andrology Unit - Metabolic Bone Diseases and Osteoporosis Section, Milan, Italy.
Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.
Neuroendocrinology. 2021;111(8):775-785. doi: 10.1159/000511811. Epub 2020 Sep 25.
Acromegaly is commonly complicated by arthropathy and skeletal fragility with high risk of vertebral fractures (VFs).
This study aimed to assess whether VFs may be associated with sagittal spine deformities, arthropathy, impaired quality of life (QoL), pain, and disability.
Thirty-eight patients with acromegaly (median age: 55 years, 20 males) and 38 matched control subjects were evaluated by a low-dose sagittal and coronal planes, X-ray imaging system (EOS®-2D/3D) for morphometric VFs, radiological signs of spine arthropathy, and spine deformities (Cobb thoracic index ≥40°, pelvic incidence minus lumbar lordosis ≥10°, pelvic tilt >20°, and sagittal vertical axis ≥4 cm) determining sagittal spine imbalance. Acromegalic patients were also evaluated by questionnaires for QoL (Acromegaly QoL Questionnaire [AcroQoL] and Short Form-36 [SF-36]) and pain and disability (Western Ontario and McMaster University [WOMAC]).
Acromegalic patients showed higher prevalence of thoracic hyperkyphosis (i.e., Cobb thoracic index ≥40°; p = 0.04) and pelvic tilt >20° (p = 0.02) than control subjects. VFs were found in 34.2% of acromegalic patients (p = 0.003 vs. control subjects), in relationship with higher prevalence of hyperkyphosis (p = 0.03), pelvic tilt >20° (p = 0.04), sagittal vertical axis ≥4 cm (p = 0.03), and moderate/severe subchondral degeneration (p = 0.01). Moreover, patients with VFs had lower AcroQoL general health (p = 0.007) and SF-36 general health (p = 0.002) scores and higher WOMAC pain (p = 0.003) and global (p = 0.009) scores than patients who did not fracture.
In acromegaly, VFs may be associated with spine deformities and sagittal imbalance, spine arthropathy, impaired QoL, and disability.
肢端肥大症常伴有关节病和骨骼脆弱，椎体骨折（VF）风险较高。
本研究旨在评估 VF 是否与脊柱矢状面畸形、关节病、生活质量（QoL）受损、疼痛和残疾有关。
对 38 例肢端肥大症患者（中位年龄 55 岁，20 例男性）和 38 例匹配的对照组进行低剂量矢状面和冠状面 X 射线成像系统（EOS®-2D/3D）评估，以评估 VF 的形态计量学、脊柱关节病的放射学征象以及脊柱畸形（Cobb 胸椎指数≥40°，骨盆入射角减去腰椎前凸≥10°，骨盆倾斜度>20°，矢状垂直轴≥4cm），以确定矢状面脊柱失衡。肢端肥大症患者还通过问卷调查评估 QoL（肢端肥大症 QoL 问卷[AcroQoL]和简明 36 项健康调查[SF-36]）和疼痛和残疾（安大略西部和麦克马斯特大学[WOMAC]）。
肢端肥大症患者的胸椎后凸（即 Cobb 胸椎指数≥40°；p=0.04）和骨盆倾斜度>20°（p=0.02）的发生率高于对照组。34.2%的肢端肥大症患者发现 VF（p=0.003 与对照组相比），与更高的后凸发生率（p=0.03）、骨盆倾斜度>20°（p=0.04）、矢状垂直轴≥4cm（p=0.03）和中/重度软骨下退变（p=0.01）有关。此外，VF 患者的 AcroQoL 一般健康状况（p=0.007）和 SF-36 一般健康状况（p=0.002）评分较低，而 WOMAC 疼痛（p=0.003）和全球（p=0.009）评分较高。
在肢端肥大症中，VF 可能与脊柱畸形和矢状面失衡、脊柱关节病、生活质量受损和残疾有关。
