Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-Ro, Jongno-Gu, Seoul, 03181, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Osteoporos Int. 2023 Sep;34(9):1591-1600. doi: 10.1007/s00198-023-06800-z. Epub 2023 May 24.
In this national cohort study, the patients with acromegaly had significantly higher risks of clinical vertebral (HR 2.09 [1.58-2.78]) and hip (HR 2.52 [1.61-3.95]) fractures than the controls. The increased fracture risk in patients with acromegaly was time-dependent and was observed even during the early period of follow-up.
Acromegaly is characterized by the overproduction of growth hormone (GH) and insulin-like growth factor-1 (IGF-1), both play important roles in regulating bone metabolism. We investigated the risk of vertebral and hip fractures in patients with acromegaly compared to age- and sex-matched controls.
This nationwide population-based cohort study included 1,777 patients with acromegaly aged 40 years or older in 2006-2016 and 8,885 age- and sex-matched controls. A Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) [95% confidence interval].
The mean age was 54.3 years and 58.9% were female. For approximately 8.5 years of follow-up, the patients with acromegaly had significantly higher risks of clinical vertebral (HR 2.09 [1.58-2.78]) and hip (HR 2.52 [1.61-3.95]) fractures than the controls in the multivariate analyses. There were significant differences in the risks of clinical vertebral (P < 0.0001) and hip (P < 0.0001) fractures between the patients with acromegaly and the controls in the Kaplan-Meier survival analysis. The multivariable-adjusted HRs for clinical vertebral fractures comparing the patients with acromegaly with controls during and excluding the first 7 years of observation were 1.69 [1.15-2.49] and 2.70 [1.75-4.17], respectively. The HRs for hip fractures during and excluding the first 7 years of observation were 2.29 [1.25-4.18] and 3.36 [1.63-6.92], respectively.
The patients with acromegaly had a higher risk of hip fractures as well as clinical vertebral fractures than the controls. The increased fracture risk in patients with acromegaly was time-dependent and was observed even during the early period of follow-up.
肢端肥大症患者的生长激素（GH）和胰岛素样生长因子-1（IGF-1）过度生成，这两者在调节骨代谢中发挥重要作用。我们调查了肢端肥大症患者与年龄和性别匹配的对照组相比，发生椎体和髋部骨折的风险。
这是一项全国范围内基于人群的队列研究，纳入了 2006 年至 2016 年期间年龄在 40 岁及以上的 1777 例肢端肥大症患者和 8885 例年龄和性别匹配的对照组。使用 Cox 比例风险模型估计调整后的风险比（HR）[95%置信区间]。
患者的平均年龄为 54.3 岁，58.9%为女性。在大约 8.5 年的随访期间，多变量分析显示肢端肥大症患者发生临床椎体（HR 2.09 [1.58-2.78]）和髋部（HR 2.52 [1.61-3.95]）骨折的风险明显高于对照组。在 Kaplan-Meier 生存分析中，肢端肥大症患者与对照组之间在临床椎体（P<0.0001）和髋部（P<0.0001）骨折风险方面存在显著差异。在多变量调整后，与对照组相比，肢端肥大症患者在观察期间（不包括前 7 年）和排除前 7 年的临床椎体骨折的 HR 分别为 1.69 [1.15-2.49]和 2.70 [1.75-4.17]。在观察期间（不包括前 7 年）和排除前 7 年的髋部骨折的 HR 分别为 2.29 [1.25-4.18]和 3.36 [1.63-6.92]。
肢端肥大症患者发生髋部骨折和临床椎体骨折的风险高于对照组。肢端肥大症患者的骨折风险随时间增加，即使在随访早期也可观察到。
