Treatment of Acromegalic Osteopathy in Real-life Clinical Practice: The BAAC (Bone Active Drugs in Acromegaly) Study

Background. Vertebral fractures (VFs) are a frequent complication of acromegaly, but no studies have been so far published on effectiveness of antiosteoporotic drugs in this clinical setting. Objective. To evaluate whether in real-life clinical practice bone active drugs may reduce the risk of VFs in patients with active or controlled acromegaly. Study design. Retrospective, longitudinal study including 9 tertiary care endocrine units. Patients and Methods. Two hundred and forty-eight patients with acromegaly (104 males; mean age 56.00 +/- 13.60 years) were evaluated for prevalent and incident VFs by quantitative morphometric approach. Bone active agents were used in 52 patients (20.97%) and the median period of follow-up was 48 months (range 12-132). Results. During the follow-up, 65 patients ( 26.21%) developed incident VFs in relationship with pre-existing VFs (odds ratio [OR] 3.75; P <.001), duration of active acromegaly (OR 1.01; P =.04), active acromegaly at the study entry (OR 2.48; P =.007), and treated hypoadrenalism (OR 2.50; P =.005). In the entire population, treatment with bone active drugs did not have a significant effect on incident VFs (P =.82). However, in a sensitive analysis restricted to patients with active acromegaly at study entry (111 cases), treatment with bone active drugs was associated with a lower risk of incident VFs (OR 0.11; P =.004), independently of prevalent VFs (OR 7.65; P <.001) and treated hypoadrenalism (OR 3.86; P =.007). Conclusions. Bone active drugs may prevent VFs in patients with active acromegaly.