Endocrine Abstracts

Objective: Studies have demonstrated that patients with acromegaly have compromised bone health and an increased risk of vertebral fractures (VFs). However, the prevalence of VFs in Chinese patients with acromegaly has not been investigated by far. This study aimed to evaluate the prevalence and determinants of VFs in patients with acromegaly in a tertiary hospital in China.

Methods: We enrolled patients diagnosed with acromegaly consecutively at West China Hospital between January 2021 and December 2023, and excluded patients with plurihormonal PIT-1 positive pituitary adenoma. Supine and lateral thoracolumbar spine X-ray was performed to detect vertebral morphometry, and Genant’s semi-quantitative criteria was applied to determine VFs.

Results: We enrolled 74 participants (48 females/26 males) in total, and found that 38 patients (51.4%) had VFs, with the majority of fractures being multiple (65.7%) and moderate/severe (63.2%). Patients with VFs were older (median age 55 vs 39 years old), and had higher parathyroid hormone (5.45 pmol/l vs 4.77 pmol/l) and apnea hypoventilation index (43.3 times/hr vs 13.9 times/hr) than the non-fractured patients. In addition, more fractured females developed menopause compared with non-fractured females (72.7% vs 26.9%, P=0.002). Patients with VFs had slightly decreased bone mineral density (BMD) in spine, femoral neck and total hip by dual-energy X-ray absorptiometry, and dramatic lower BMD in spine by quantitative computed tomography compared with those without VFs (121.4 g/cm3 vs 171.6 g/cm3, P<0.005). However, growth hormone (GH) level was higher in patients without VFs. The insulin-like growth factor-1, beta-C-terminal telopeptide and total type I collagen N-terminal propeptide were not comparable in the two groups. Nevertheless, binary logistic regression analysis showed that GH level (OR 1.018; 95% CI, 1.000-1.035; P=0.050) and age≥50 years/menopause (OR 4.462; 95% CI, 1.489-13.368; P=0.008) were two independent predicting factors of VFs.

Conclusion: This study indicates a high prevalence of VFs among patients with acromegaly in China for the first time. Findings in our study also remind us of the need to evaluate bone health in patients with acromegaly, especially in those with higher GH level, older age, or female patients with menopause.