Fracture risk is increased in patients with GH deficiency or untreated prolactinomas--a case-control study.
OBJECTIVE
The pituitary secretes many hormones of significance to bone turnover and thus skeletal integrity. The aim of this study was to examine fracture risk in patients with pituitary disorders with special reference to GH deficiency and hyperprolactinaemia.


METHODS
Case-control study.


METHODS
Fracture occurrence.


METHODS
A self-administered questionnaire was issued to 537 consecutive patients with pituitary disorders excluding Cushing's disease. A total of 426 (79%) returned the questionnaire and 422 of these could be analysed. Each respondent was compared to three age- and gender-matched control respondents to the same questionnaire drawn randomly from the background population.


RESULTS
The patients had a mean age of 51.4 +/- 14.8 years. One hundred and eight patients had acromegaly, 86 had prolactinomas, 136 had non-functioning pituitary adenomas (NFPA), 23 had craniopharyngiomas, and 73 had other types of pituitary disorders. For the total group the fracture risk was not elevated either before or after confirmed diagnosis compared to controls. However, among the patients with prolactinomas, the fracture risk was significantly increased before (relative risk, RR = 1.6, 95% CI: 1.1--2.3) but not after diagnosis. In patients with NFPA, fracture risk was borderline significantly elevated following diagnosis (RR = 1.6, 95% CI: 1.0--2.6). Patients with subnormal stimulated peak GH values suggestive of GH deficiency had a significantly higher risk of fractures after diagnosis than patients who had normal stimulated peak GH values (odds ratio, OR = 4.90, 95% CI: 1.10--21.88).


CONCLUSIONS
Untreated prolactinomas were associated with a significant increase in fracture risk. Growth hormone deficiency was also associated with a higher fracture risk.
Vestergaard
Peter
P
Department of Endocrinology, Aarhus Amtssygehus, Medical Department M (Endocrinology and Diabetes), Aarhus Kommunehospital, Aarhus, University Hospital, Aarhus, Denmark. p-vest@post4.tele.dk
Jørgensen
Jens Otto L
JO
Hagen
Claus
C
Hoeck
Hans Christian
HC
Laurberg
Peter
P
Rejnmark
Lars
L
Brixen
Kim
K
Weeke
Jørgen
J
Andersen
Marianne
M
Conceicao
Flavia L
FL
Nielsen
Torben Leo
TL
Mosekilde
Leif
L
D000236:Adenoma / Q000150:complications; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003397:Craniopharyngioma / Q000150:complications; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D013006:Growth Hormone / Q000172:deficiency*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications*; D015175:Prolactinoma / Q000150:complications*; D012044:Regression Analysis; D012306:Risk; D011795:Surveys and Questionnaires
D013006:Growth Hormone