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The Negative Impacts of Acromegaly on Bone Microstructure Not Fully Reversible
Frontiers in Endocrinology ( IF 5.2 ) Pub Date : 2021-09-15 , DOI: 10.3389/fendo.2021.738895
Lian Duan 1 , Shengmin Yang 1 , Lin Jie Wang 1 , Yuelun Zhang 2 , Ran Li 1 , Hongbo Yang 1 , Yuxing Zhao 1 , Hanze Du 1 , Xiao Zhai 1 , Fengying Gong 1 , Hui Pan 1 , Huijuan Zhu 1 , Weibo Xia 1
Affiliation  

Purpose

This study aimed to evaluate the bone turnover markers and bone microarchitecture parameters derived from high-resolution peripheral quantitative computed tomography (HR-pQCT) in active and controlled acromegaly patients.

Methods

This cross-sectional study involved 55 acromegaly patients from a tertiary hospital (23 males and 32 females, aged 45.0 ± 11.6 years). Firstly, growth hormone (GH), insulin-like growth factor-1 (IGF-1), and markers for bone turnover were assessed. Next, we derived peripheral bone microstructure parameters and volumetric bone mineral density (vBMD) through HR-pQCT. These parameters were compared between acromegaly patients and 110 healthy controls, as well as between 27 active and 28 controlled acromegaly patients. Moreover, the relationship between GH/IGF-1 and bone microstructure parameters was analyzed through multiple linear regression.

Results

As compared with healthy controls, acromegaly patients exhibited elevated cortical vBMD, reduced trabecular vBMD, and increased trabecular inhomogeneity in the distal radius and tibia. While controlled acromegaly patients had slower bone turnover, they did not necessarily have better bone microstructure relative to active patients in intergroup comparison. Nevertheless, multiple regression indicated that higher IGF-1 was associated with lower tibial stiffness and failure load. Additionally, males with higher IGF-1 typically had larger trabecular separation, lower trabecular number, and larger cortical pores in the radius. Moreover, patients with elevated GH typically had more porous cortical bone in the radius and fewer trabeculae in the tibia. However, the compromised bone strength in active patients was partially compensated by increased bone thickness. Furthermore, no significant linkage was observed between elevated GH/IGF-1 and the most important HR-pQCT parameters such as trabecular volumetric bone density.

Conclusion

Acromegaly adversely affected bone quality, even in controlled patients. As the deterioration in bone microstructure due to prolonged GH/IGF-1 exposure was not fully reversible, clinicians should be aware of the bone fragility of acromegaly patients even after they had achieved biochemical remission.



中文翻译:

肢端肥大症对骨显微结构的负面影响不完全可逆

Purpose

本研究旨在评估来自活动性和受控肢端肥大症患者的高分辨率外周定量计算机断层扫描 (HR-pQCT) 的骨转换标志物和骨微结构参数。

Methods

这项横断面研究涉及来自一家三级医院的 55 名肢端肥大症患者(23 名男性和 32 名女性,年龄 45.0 ± 11.6 岁)。首先,评估了生长激素 (GH)、胰岛素样生长因子-1 (IGF-1) 和骨转换标志物。接下来,我们通过 HR-pQCT 推导出外周骨微结构参数和体积骨矿物质密度 (vBMD)。这些参数在肢端肥大症患者和 110 名健康对照之间以及 27 名活动性肢端肥大症患者和 28 名受控肢端肥大症患者之间进行了比较。此外,通过多元线性回归分析GH/IGF-1与骨微结构参数之间的关系。

Results

与健康对照组相比,肢端肥大症患者表现出皮质 vBMD 升高,小梁 vBMD 降低,桡骨远端和胫骨小梁不均匀性增加。虽然受控肢端肥大症患者骨转换较慢,但在组间比较中,与活跃患者相比,他们不一定具有更好的骨微结构。然而,多元回归表明,较高的 IGF-1 与较低的胫骨刚度和故障负荷相关。此外,具有较高 IGF-1 的男性通常具有较大的小梁分离、较低的小梁数量和较大的桡骨皮质孔。此外,GH升高的患者通常在桡骨有更多的多孔皮质骨,而在胫骨有更少的小梁。然而,活动患者的骨强度受损部分通过增加骨厚度得到补偿。此外,在升高的 GH/IGF-1 和最重要的 HR-pQCT 参数(如小梁体积骨密度)之间没有观察到显着的联系。

Conclusion

肢端肥大症对骨质量产生不利影响,即使在对照患者中也是如此。由于长时间 GH/IGF-1 暴露导致的骨微结构恶化并非完全可逆,因此临床医生应注意肢端肥大症患者的骨脆性,即使他们已经达到生化缓解。

更新日期:2021-09-15
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