ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
Treatment of acromegalic osteopathy in the real-life clinical practice: The baac (bone active drugs in acromegaly) multicenter study
Gherardo Mazziotti 1 , Claudia Battista 2 , Sabrina Chiloiro 3 , Filippo Maffezzoni 4 , Emanuele Ferrante 5 , Silvia Grottoli 6 , Ludovica Grasso 7 , Federico Gatto 8 , Roberto Olivetti 9 , Maura Arosio 5 , Antonio Bianchi 3 , Giulia Carosi 5 , Miriam Cellini 10 , Iacopo Chiodini 11 , Laura De Marinis 3 , Carolina Di Somma 7 , Alberto Ferlin 4 , Ezio Ghigo 6 , Elisabetta Lavezzi 10 , Giovanna Mantovani 5 , Rosario Pivonello 7 , Teresa Porcelli 4 , Nunzia Prencipe 6 , Massimo Procopio 6 , Alfredo Scillitani 2 & Andrea Lania 1
1Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS; Department of Clinical Sciences, Humanitas University, Milan, Italy; 2Unit of Endocrinology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo (FG), Italy; 3Pituitary Unit, Department of Endocrinology and Metabolic Diseases, Fondazione Policlinico ‘A. Gemelli’, IRCCS – Universita’ Cattolica del Sacro Cuore, Rome, Italy; 4Endocrinology and Metabolism, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; 5Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico – Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 6Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Turin, Italy; 7Endocrinology Section, Department of Clinical and Surgical Medicine, University Federico II, Naples, Italy; 8Endocrinology Unit, San Martino Hospital, IRCCS – Department of Internal Medicine CEBR, University of Genoa, Genoa, Italy; 9Endocrine Unit, ASST Carlo Poma, Mantua, Italy; 10Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano (MI), Italy; 11Unit for Bone Metabolism Diseases and Diabetes & Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Osteopathy is an emerging complication of acromegaly, characterized by increased bone turnover, profound abnormalities in trabecular bone structure and high risk of vertebral fractures (VFs). The therapeutic management of skeletal fragility in acromegaly is a challenge, since the risk of fractures may remain high after the control of acromegaly and the effectiveness of bone-active drugs in this clinical setting is unknown. In this retrospective-multicenter study, we aimed at evaluating the effectiveness of bone-active drugs on risk of VFs in patients with active or controlled acromegaly. Two-hundred-forty-eight patients with acromegaly (114 females; median age 57 years, range 21–88; 137 patients with active acromegaly) were evaluated for prevalent and incident VFs by a quantitative morphometric approach. At the study entry, prevalent VFs were found in 78 patients (31.5%). Treatment with bone-active drugs was performed in 52 patients (21%): oral bisphosphonates in 39 cases, oral raloxifene in 2 cases, oral strontium ranelate in 1 case, i.v. zoledronate in 1 case, s.c. teriparatide in 3 cases, s.c. denosumab in 3 cases, multiple therapies in 3 cases. The median follow-up was 48 months (range: 12–132); for homogeneity, the follow-up was categorized in 1–2 years (48 cases), 2–4 years (84 cases), 4–6 years (93 cases) and > 6 years (23 cases). During the follow-up, 65 patients (26.2%) experienced incident VFs in relationship with pre-existing VFs (HR 2.76; C.I. 95% 1.64–4.65; P < 0.001) and duration of active acromegaly (HR 1.01; C.I. 95%, 1.002–1.02; P = 0.005), independently of age (P = 0.39), sex (P = 0.45), hypogonadism (P-0.99) and diabetes (P = 0.94). Treatment with bone-active drugs decreased the risk of incident VFs only in patients with active acromegaly at the study entry (HR 0.20, C.I. 95% 0.06–0.68; P = 0.01), independently of prevalent VFs (P = 0.002). The effect of bone-active drugs on risk of VFs was not statistically significant in patients with cured/controlled acromegaly (HR 0.61, C.I. 95% 0.26–1.40 P = 0.24). In conclusion, this multicenter study showed for the first time that bone-active drugs (i.e., most of them with inhibitory effects on bone resorption) may prevent VFs in patients with active acromegaly. Future prospective studies are needed to assess whether anabolic and anti-resorptive bone-active drugs may have different effects in decreasing the risk of VFs in patients with active and controlled acromegaly.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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