Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Yonsei University Graduate School of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2023 Dec;38(6):690-700. doi: 10.3803/EnM.2023.1782. Epub 2023 Oct 30.
Acromegaly leads to various skeletal complications, and fragility fractures are emerging as a new concern in patients with acromegaly. Therefore, this study investigated the risk of fractures in Korean patients with acromegaly.
We used the Korean nationwide claims database from 2009 to 2019. A total of 931 patients with acromegaly who had never used an osteoporosis drug before and were treated with surgery alone were selected as study participants, and a 1:29 ratio of 26,999 age- and sex-matched osteoporosis drug-naïve controls without acromegaly were randomly selected from the database.
The mean age was 46.2 years, and 50.0% were male. During a median follow-up of 54.1 months, there was no difference in the risks of all, vertebral, and non-vertebral fractures between the acromegaly and control groups. However, hip fracture risk was significantly higher (hazard ratio [HR], 2.73; 95% confidence interval [CI], 1.32 to 5.65), and non-hip and non-vertebral fractures risk was significantly lower (HR, 0.40; 95% CI, 0.17 to 0.98) in patients with acromegaly than in controls; these results remained robust even after adjustment for socioeconomic status and baseline comorbidities. Age, type 2 diabetes mellitus, cardio-cerebrovascular disease, fracture history, recent use of acid-suppressant medication, psychotropic medication, and opioids were risk factors for all fractures in patients with acromegaly (all P<0.05).
Compared with controls, patients surgically treated for acromegaly had a higher risk of hip fractures. The risk factors for fracture in patients with acromegaly were consistent with widely accepted risk factors in the general population.
肢端肥大症可导致多种骨骼并发症，脆性骨折已成为肢端肥大症患者的新关注点。因此，本研究旨在探讨韩国肢端肥大症患者发生骨折的风险。
我们使用了 2009 年至 2019 年韩国全国索赔数据库。共纳入 931 例从未使用过骨质疏松症药物且仅接受手术治疗的肢端肥大症患者作为研究对象，并从数据库中按年龄和性别 1:29 的比例随机选择 26999 例从未使用过骨质疏松症药物且无肢端肥大症的年龄和性别匹配的骨质疏松症药物对照者。
患者的平均年龄为 46.2 岁，50.0%为男性。中位随访 54.1 个月期间，肢端肥大症组与对照组的所有、椎体和非椎体骨折风险均无差异。然而，肢端肥大症组的髋部骨折风险显著更高（风险比[HR]，2.73；95%置信区间[CI]，1.32 至 5.65），非髋部和非椎体骨折风险显著更低（HR，0.40；95%CI，0.17 至 0.98）；即使在校正社会经济地位和基线合并症后，结果仍具有稳健性。年龄、2 型糖尿病、心脑血管疾病、骨折史、近期使用抑酸药物、精神药物和阿片类药物是肢端肥大症患者发生所有骨折的危险因素（均 P<0.05）。
与对照组相比，手术治疗的肢端肥大症患者发生髋部骨折的风险更高。肢端肥大症患者骨折的危险因素与一般人群中广泛认可的危险因素一致。
