Spine Bone Texture Assessed by Trabecular Bone Score in Active and Controlled Acromegaly: A Prospective Study

Context: Acromegalic patients have an increased vertebral fracture (VFx) risk due to bone quality reduction, independently of bone mineral density (BMD). Objective: The aim of the study is to describe bone quality in acromegaly, measured by trabecular bone score (TBS), a noninvasive index for assessing bone microarchitecture. Methods: We collected data from 18 patients (13 female, age 56.2 +/- 15 years) newly diagnosed with acromegaly. Thirty-six age- and sex-matched healthy controls were also recruited. Pituitary function, bone and calcium-phosphorous metabolism, and BMD at spine and femur and TBS (by dual-energy x-ray absorptiometry) were assessed in acromegalic patients at diagnosis and 12 months after the achievement of insulin-like growth factor 1 (IGF-1) normalization. Results: At diagnosis, BMD and the VFx prevalence were comparable between patients and controls (28.3 +/- 5.9 vs 27.6 +/- 3.7 and 11% vs 8.3%), whereas TBS was significantly lower in acromegalic patients (1.20 +/- 0.13 vs 1.30 +/- 0.06; P< .001) and carboxytermi nal telopeptide (CTX) and osteocalcin were significantly higher compared to controls (707 +/- 365.7 vs 371 +/- 104.1 pg/mL; P= .001 and 31.6 +/- 15.4 vs 17.0 +/- 5.7 ng/ mL; P= .001, respectively). One year after IGF-1 normalization, a significant reduction of bone turnover indexes was observed in the group of acromegalic patients surgically cured (osteocalcin decrease of 61.2%, CTX decrease of 60.3%) compared to the ones controlled by medical therapy (osteocalcin decrease of 39%, CTX decrease of 40.7%; P= .01 and P = .001, respectively). Despite these findings, noTBS or BMD variations were observed. Conclusion: Acromegalic patients have impaired bone quality despite normal density. Achieving normal growth hormone secretion rapidly leads to the normalization of bone turnover.

Automated summary

Acromegalic patients have impaired bone quality despite normal density. Achieving normal growth hormone secretion rapidly leads to the normalization of bone turnover. Surgical cure results in a greater reduction of bone turnover markers compared to medical therapy.