Sorohan Madalina Cristina, Baciu Ionela Florina, Galoiu Simona Andreea, Niculescu Dan Alexandru, Caragheorgheopol Andra, Iordachescu Carmen Nicoleta, Poiana Catalina
Carol Davila University of Medicine and Pharmacy, Aviatorilor Boulevard, Nr. 34-38, Bucharest, Romania.
Carol Davila University of Medicine and Pharmacy, Aviatorilor Boulevard, Nr. 34-38, Bucharest, Romania; CI Parhon National Institute of Endocrinology, Bucharest, Romania.
Ann Endocrinol (Paris). 2023 Dec;84(6):719-726. doi: 10.1016/j.ando.2023.08.005. Epub 2023 Sep 7.
Osteopathy in patients with acromegaly is characterized by increased prevalence of vertebral fragility fractures (VF). However, the diagnostic criteria for osteoporosis are seldomly met in terms of bone mineral density (BMD), as patients with acromegaly frequently present normal BMD for age and gender.
We performed a cross-sectional study on 71 patients with acromegaly and 75 patients with hypogonadism. Turnover markers comprised alkaline phosphatase, osteocalcin, the C-terminal telopeptide of type I collagen and total procollagen type-1 amino-terminal propeptide; imaging comprised dual x-ray absorptiometry for BMD, T and Z scores of the lumbar spine, femoral neck and total hip, trabecular bone score (TBS), and x-ray scans of the thoracic and lumbar spine.
Vertebral fractures (VF) in subjects with acromegaly were significantly more frequent than in subjects with hypogonadism, with a prevalence of 29.6% compared to 9.3%. Patients with acromegaly had significantly higher BMD at all skeletal sites but lower TBS than hypogonadal subjects. This difference remained statistically significant after grouping patients with acromegaly according to gonadal status and comparing them with patients with hypogonadism. However, presence of hypogonadism in patients with acromegaly did not influence BMD, TBS or VF prevalence. Moreover, patients with active acromegaly did not have significantly different BMD, TBS and VF prevalence compared to patients with controlled disease. Patients with acromegaly with VF had significantly lower BMD at all skeletal sites than those without VF, but no difference in TBS.
Vertebral fractures are frequent in acromegaly, and are associated with lower BMD but not with TBS. Patients with acromegaly, regardless of gonadal status, have significantly higher BMD but lower TBS than hypogonadal patients. Moreover, disease activity and hypogonadism do not influence BMD, TBS or VF in acromegaly.
肢端肥大症患者的骨病表现为椎体脆性骨折（VF）患病率增加。然而，就骨矿物质密度（BMD）而言，很少符合骨质疏松症的诊断标准，因为肢端肥大症患者的BMD通常在年龄和性别方面处于正常水平。
我们对71例肢端肥大症患者和75例性腺功能减退患者进行了一项横断面研究。骨转换标志物包括碱性磷酸酶、骨钙素、I型胶原C末端肽和I型前胶原氨基端前肽总量；影像学检查包括双能X线吸收法测量腰椎、股骨颈和全髋部的BMD、T值和Z值、骨小梁评分（TBS）以及胸腰椎X线扫描。
肢端肥大症患者的椎体骨折（VF）发生率显著高于性腺功能减退患者，患病率分别为29.6%和9.3%。肢端肥大症患者在所有骨骼部位的BMD均显著高于性腺功能减退患者，但TBS低于后者。根据性腺状态对肢端肥大症患者进行分组并与性腺功能减退患者比较后，这种差异仍具有统计学意义。然而，肢端肥大症患者中存在性腺功能减退并不影响BMD、TBS或VF患病率。此外，与疾病得到控制的患者相比，活动期肢端肥大症患者的BMD、TBS和VF患病率无显著差异。患有VF的肢端肥大症患者在所有骨骼部位的BMD均显著低于未发生VF的患者，但TBS无差异。
椎体骨折在肢端肥大症中很常见，且与较低的BMD相关，但与TBS无关。无论性腺状态如何，肢端肥大症患者的BMD均显著高于性腺功能减退患者，但TBS低于后者。此外，疾病活动度和性腺功能减退并不影响肢端肥大症患者的BMD、TBS或VF。
