ECE2024 Poster Presentations Pituitary and Neuroendocrinology (120 abstracts)
DXA-derived lumbar bone strain index corrected for kyphosis is associated with vertebral fractures in acromegaly
Simona Jafaar 1,2 , Giacomo Cristofolini 1,2 , Emanuela Morenghi 1,3 , Luca Rinaudo 4 , Maria Francesca Birtolo 1,2 , Elisa Sala 5 , Emanuele Ferrante 5 , Roberta Mungari 5 , Elisabetta Lavezzi 2 , Lorenzo Leonardi 6 , Pasquala Ragucci 6 , Fabio Massimo Ulivieri 7 , Luca Balzarini 6 , Giovanna Mantovani 5,8 , Andrea Lania 1,2 & Gherardo Mazziotti 1,2
1Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; 2IRCCS Humanitas Research Hospital, Endocrinology, Diabetology and Andrology Unit, Rozzano, Italy; 3IRCCS Humanitas Research Hospital, Biostatistics Unit, Rozzano, Italy; 4Tecnologie Avanzate S.r.l, Turin, Italy; 5Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy; 6IRCCS Humanitas Research Hospital, Department of Radiology, Rozzano, Italy; 7Casa di Cura la Madonnina, Bone Metabolic Unit, Milan, Italy; 8University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
The bone strain index (BSI) is a marker of bone deformation based on a finite element analysis inferred from dual X-ray absorptiometry (DXA) scans, that has been proposed as a predictor of fractures in osteoporosis. BSI value represents the average equivalent strain in a skeletal site, assuming that a higher strain level (higher BSI) indicates a lower bone’s resistance to loads with consequent higher risk of fractures. BSI index is usually calculated for specific loading condition (e.g. standing for the lumbar site), but for particular reasons the load may vary due to external conditions (e.g. load bearing) or spine. These conditions possibly affecting BSI have been frequently described in patients with acromegaly. We aimed to investigate the association between lumbar BSI and vertebral fractures (VFs) in acromegaly. Twenty-three patients with acromegaly (13 males, mean age 58 years; three with active disease) were evaluated for morphometric VFs, trabecular bone score (TBS), bone mineral density (BMD) and lumbar BSI, the latter being corrected for the kyphosis as measured by low-dose X-ray imaging system (EOS®-2D/3D). In particular, for each degree increase of the sagittal Cobb angle, the force applied to the upper surface of the vertebra was increased by approximately 6% according to uncompensated position and the information derived from the lateral image coming from EOS device. Impaired TBS (i.e., TBS <1.310), low BMD (i.e., BMD T-score ≤-1.0 SD) at either skeletal site and pathological lumbar BSI (i.e., BSI≥2.4) were found in 10 (43.50%), 13 (56.50%) and 6 (26.09%) patients, respectively. Patients with pathological lumbar BSI showed more frequently impaired TBS as compared to those with normal lumbar BSI (83.30% vs 29.40%; P=0.05), without differences in age, duration of active disease, serum IGF-I values, current medical therapies of acromegaly, coexistent hypopituitarism, previous treatment with bone-active drugs and low BMD at either skeletal site. Lumbar BSI was significantly higher in patients with VFs (13 cases) as compared to those without fractures (2.26, 95%C.I. 1.3-5.7 vs 1.85, 95%C.I. 1.16-2.22; P=0.040). 6 out of 13 (46.15%) patients with VFs had pathological BSI, whereas all patients without VFs had normal BSI (P=0.019). Patients with VFs had also more frequently impaired TBS vs patients without VFs (61.50% vs 20.00%; P=0.04). In conclusion, lumbar BSI corrected for kyphosis could be proposed as integrated parameter of spine arthropathy and osteopathy in acromegaly helping the clinicians in identifying patients predisposed to VFs.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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