ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
Association between sagittal spine imbalance and radiological vertebral fractures in acromegaly: Does it reflect a pathophysiological link?
Miriam Cellini 1 , Emilia Biamonte 1 , Nicoletta Trenti 2 , Massimiliano Mazza 1 , Davide Milani 3 , Emanuele Ferrante 4 , Elisabetta Lavezzi 1 , Giovanna Mantovani 5 , Maura Arosio 5 , Maurizio Fornari 3 , Luca Balzarini 2 , Andrea Lania 6 & Gherardo Mazziotti 6
1Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano (MI), Italy; 2Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; 3Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy; 4Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 5Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico – Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 6Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS; Department of Clinical Sciences, Humanitas University, Rozzano (MI), Italy
Chronic exposure to GH hypersecretion may alter the physiological balance of the spine through inducing degeneration of intervertebral discs and impaired trophism of facet joints. Moreover, GH in excess may also cause profound deterioration in bone microstructure with consequent increase in risk of fragility vertebral fractures (VFs). In this cross-sectional study,we evaluated for the first time in acromegaly the association between spine imbalance and VFs. Thirty-eight patients with acromegaly (median age 55 years; 20 males; 12 with active disease) were consecutively evaluated for sagittal spine parameters and morphometric VFs (EOS imaging system, Paris, France), quality of life (SF-36 questionnaire), pain and disability (Womac questionnaire). Thirty-eight subjects without history of pituitary disease, matched for age and sex with acromegalic patients, acted as controls for evaluation of VFs. VFs were significantly more frequent in acromegaly patients as compared to control subjects (34.2% vs 5.3%; P = 0.003). All fractured patients with acromegaly had VFs in the thoracic tract with spine deformity index (SDI) ranging from 1 to 9. In acromegaly, the prevalence of VFs was significantly higher in patients with kyphosis (i.e., thoracic Cobb angle >50%) as compared to those without kyphosis (55.6% vs 15.0; P = 0.02). The thoracic Cobb angle in fractured patients was not associated with the SDI (P = 0.61). In acromegalic patients without VFs, the thoracic Cobb angle was significantly associated with lumbar Cobb angle (P = 0.003), which in turn was significantly associated with sacral slope (P < 0.001) and pelvic incidence (P < 0.001) reflecting compensatory adapation of the spine. These associations were not found in patients with VFs. Acromegaly patients with VFs showed also lower SF-36 Health score (P = 0.002) and higher Womac-pain score (P = 0.03) as compared to patients who did not fracture. The association between VFs and SF-36 Health score remained significant (P = 0.005) after correction for the thoracic Cobb angle, whereas that with the Womac-pain score was lost (P = 0.16). In conclusion, this study provided a first evidence that: 1) VFs may be associated with spinal kyphosis and sagittal imbalance in acromegaly, likely reflecting an effect ofabnormal spinal compressive loading on fracture risk, such as already demonstrated in post-menopausal osteoporosis; 2) VFs may impact on quality of life of patients with acromegaly, independent of kyphosis; 3) the low dose biplane X-ray imaging system may be proposed in the real-life clinical practice asa reliable diagnostic tool for a comprehensive evaluation of spine arthopathy and VFs in acromegaly.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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