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Acromegaly associated with negative effects on trabecular bone
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Acromegaly is a known factor of secondary osteoporosis, but studies have reported conflicting data on bone mineral density and the evaluation of the bone properties associated with this rare disease.
According to data from a recent study, acromegaly appears to have a negative effect on trabecular bone, but not cortical bone.
Researchers included 82 patients (50 women, 32 men) with eugonadism or hypogonadism to correlate BMD and bone microarchitecture, using DXA and high-resolution peripheral quantitative CT. The bone parameters of patients with type 2 diabetes and disease activity were compared between the 45 patients with eugonadism and 45 healthy controls, according to data.
Researchers wrote that patients with acromegaly and type 2 diabetes (n=29) had lower trabecular density and trabecular bone volume to tissue volume ratio in the distal tibia vs. patients without type 2 diabetes (n=53).
Moreover, those with active acromegaly (n=50) demonstrated a higher BMD and T-score in the lumbar spine (P=.02 for both) and a higher cortical density in the distal tibia vs. patients with controlled acromegaly (n=32; P=.001). After further analysis and accounting for age, presence of type 2 diabetes, acromegaly activity and gonadal status, researchers determined that eugonadism remained the main influence of bone parameters. In a fourth analysis, researchers found that patients with acromegaly and eugonadism displayed lower trabecular densities and impaired microstructures vs. healthy controls.
These findings suggest that acromegaly has a negative effect on trabecular bone microarchitecture. Additionally, high-resolution peripheral quantitative CT has the potential to evaluate bone properties related to acromegaly, and for addressing limitations of DXA, they wrote.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Laurence Katznelson, MD
Studies investigating the effects of acromegaly on bone mineral density have been conflicting, but have suggested that acromegaly may be associated with enhanced bone mass and that gonadal status is a strong determinant of bone mineral density in such patients. These studies mostly use DXA scans, which are limited given the inability of DXA to distinguish bone compartments and the fact that DXA results may be altered by changes in bone mass, which may be affected by acromegaly.
This study utilizes high-resolution peripheral quantitative computed tomography, a more sensitive measurement, to evaluate the bone compartments of the radius and tibia in subjects with acromegaly and controls. With this technique, the study showed that acromegaly is associated with impaired trabecular bone microarchitecture. This study also supported previous findings on the impact of gonadal status on bone density. This study helps delineate the effects of growth hormone hypersecretion itself on the architecture of individual bone compartments.
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