Brunetti Alessandro, Cellini Miriam, Lavezzi Elisabetta, Zerbi Alessandro, Ferrillo Giuseppe, Birtolo Maria Francesca, Berruti Alfredo, Cavati Guido, Lagana Marta, Gennari Luigi, Girometti Rossano, Zuiani Chiara, Grimaldi Franco, Lania Andrea G, Vescini Fabio, Mazziotti Gherardo
Endocrinology Unit, University Hospital S. Maria della Misericordia, Udine, Italy.
Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
J Neuroendocrinol. 2025 Sep;37(9):e70053. doi: 10.1111/jne.70053. Epub 2025 Jun 1.
Patients with gastroenteropancreatic-neuroendocrine tumors (GEP-NETs) may present skeletal fragility that might be related to multiple factors, including bone metastases, vitamin D deficiency, hormone secretion, and disease treatments. This study examines the prevalence and determinants of fragility fractures in low grading (G1-G2) GEP-NETs. This retrospective study included 291 patients with G1-G2 GEP-NETs (154 men and 137 women). A longitudinal examination was available for 247 patients, with a median follow-up of 49 months (range 24-83). Information regarding disease course, osteo-metabolic profile, and clinical fractures were collected from electronic medical records. Opportunistic chest-abdomen computed tomography or magnetic resonance imaging scans were retrospectively examined to investigate morphometric vertebral fractures. Fracture prevalence in men over 50 and post-menopausal women (n = 200) was compared to an age-matched control sample of 1010 subjects (146 men and 864 women). Forty-five patients with GEP-NETs (15.5%) had fragility fractures at diagnosis of disease. Fractures were significantly associated with age, body mass index, comorbidities, and severe vitamin D deficiency (25(OH)vitamin D < 10 ng/mL) at univariate analysis, and to severe vitamin D deficiency (p = .03) and age (p = .01) at multivariate analysis. When compared to the control group, GEP-NETs patients were found to be independently associated with fractures (OR 2.0 IC95% [1.1-3.6], p = .02). At longitudinal evaluation, 10% of GEP-NETs experienced new fractures in relation to pre-existing fractures and surgical treatment of the tumor. This study provides first evidence that GEP-NETs may have a high risk of fragility fractures at the diagnosis of the disease. A proper and early assessment of bone health is therefore advisable in these patients.
胃肠胰神经内分泌肿瘤（GEP-NETs）患者可能存在骨骼脆弱性，这可能与多种因素有关，包括骨转移、维生素D缺乏、激素分泌和疾病治疗。本研究调查低分级（G1-G2）GEP-NETs患者中脆性骨折的患病率及其决定因素。这项回顾性研究纳入了291例G1-G2 GEP-NETs患者（154例男性和137例女性）。对247例患者进行了纵向检查，中位随访时间为49个月（范围24-83个月）。从电子病历中收集有关疾病病程、骨代谢情况和临床骨折的信息。回顾性检查了机会性胸腹部计算机断层扫描或磁共振成像扫描，以调查形态计量学椎体骨折。将50岁以上男性和绝经后女性（n = 200）的骨折患病率与1010名受试者（146名男性和864名女性）的年龄匹配对照样本进行比较。45例GEP-NETs患者（15.5%）在疾病诊断时发生了脆性骨折。在单因素分析中，骨折与年龄、体重指数、合并症和严重维生素D缺乏（25(OH)维生素D < 10 ng/mL）显著相关，在多因素分析中与严重维生素D缺乏（p = 0.03）和年龄（p = 0.01）相关。与对照组相比，发现GEP-NETs患者与骨折独立相关（OR 2.0 IC95% [1.1-3.6]，p = 0.02）。在纵向评估中，10%的GEP-NETs患者因既往骨折和肿瘤手术治疗而发生新的骨折。本研究首次提供证据表明，GEP-NETs在疾病诊断时可能有较高的脆性骨折风险。因此，建议对这些患者进行适当和早期的骨健康评估。
