Bioletto Fabio, Berton Alessandro Maria, Barale Marco, Aversa Luigi Simone, Sauro Lorenzo, Presti Michela, Mocellini Francesca, Sagone Noemi, Ghigo Ezio, Procopio Massimo, Grottoli Silvia
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy.
Division of Oncological Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy.
Pituitary. 2024 Dec;27(6):789-801. doi: 10.1007/s11102-024-01447-3. Epub 2024 Sep 6.
Pituitary hormones play a crucial role in regulating skeletal physiology, and skeletal fragility is a frequent complication of pituitary diseases. The ability to predict the risk of fracture events is crucial for guiding therapeutic decisions; however, in patients with pituitary diseases, fracture risk estimation is particularly challenging. Compared to primary osteoporosis, the evaluation of bone mineral density by dual X-ray absorptiometry is much less informative about fracture risk. Moreover, the reliability of standard fracture risk calculators does not have strong validations in this setting. Morphometric vertebral assessment is currently the cornerstone in the assessment of skeletal fragility in patients with pituitary diseases, as prevalent fractures remain the strongest predictor of future fracture events. In recent years, new tools for evaluating bone quality have shown promising results in assessing bone impairment in patients with pituitary diseases, but most available data are cross-sectional, and evidence regarding the prediction of incident fractures is still scarce. Of note, apart from measures of bone density and bone quality, the estimation of fracture risk in the context of pituitary hyperfunction or hypofunction cannot ignore the evaluation of factors related to the underlying disease, such as its severity and duration, as well as the specific therapies implemented for its treatment. Aim of this review is to provide an up-to-date overview of all major evidence regarding fracture risk prediction in patients with pituitary disease, highlighting the need for a tailored approach that critically integrates all clinical, biochemical, and instrumental data according to the specificities of each disease.
垂体激素在调节骨骼生理方面起着关键作用，骨骼脆弱是垂体疾病常见的并发症。预测骨折事件风险的能力对于指导治疗决策至关重要；然而，对于垂体疾病患者，骨折风险评估尤其具有挑战性。与原发性骨质疏松症相比，通过双能X线吸收法评估骨密度对于骨折风险的信息提供要少得多。此外，标准骨折风险计算器的可靠性在这种情况下尚未得到有力验证。形态计量学椎体评估目前是垂体疾病患者骨骼脆弱性评估的基石，因为既往骨折仍然是未来骨折事件最强的预测因素。近年来，评估骨质量的新工具在评估垂体疾病患者的骨损伤方面显示出有前景的结果，但大多数现有数据是横断面的，关于预测新发骨折的证据仍然很少。值得注意的是，除了骨密度和骨质量测量外，在垂体功能亢进或减退的情况下评估骨折风险不能忽视对与基础疾病相关因素的评估，如疾病的严重程度和持续时间，以及针对其治疗所实施的具体疗法。本综述的目的是提供关于垂体疾病患者骨折风险预测的所有主要证据的最新概述，强调需要一种根据每种疾病的特点严格整合所有临床、生化和仪器数据的定制方法。
