title: Increased prevalence of radiological spinal deformities in active acromegaly: a cross-sectional study in postmenopausal women.
abstract: This cross-sectional study shows that high numbers of postmenopausal women with acromegaly develop vertebral fractures in relation to the activity of disease. In patients with active acromegaly, vertebral fractures occur even in presence of normal BMD, whereas in patients with controlled acromegaly, vertebral fractures are always accompanied by a pathological BMD.
  
  
  BACKGROUND
  We studied the frequency of radiological vertebral fractures in a cohort of postmenopausal women with active or controlled acromegaly.
  
  
  METHODS
  Thirty-six postmenopausal acromegalic patients (15 with active and 21 with controlled disease) were evaluated for BMD, bone metabolism (serum 25-hydroxyvitamin D, PTH, bone-specific alkaline phosphatase [BSALP], and urinary deoxypyridinoline [Dpd]), and vertebral quantitative morphometry. Thirty-six nonacromegalic postmenopausal women, matched for age, were selected among the patients consulting the Bone Center as a control group for BMD evaluation and vertebral quantitative morphometry.
  
  
  RESULTS
  Vertebral fractures were shown in 19 patients (52.8%) and 11 controls (30.6%; chi2: 3.7; p=0.06). Fractured acromegalic women were older and had higher serum IGF-1, Dpd, and BSALP and lower T score and serum vitamin D values compared with nonfractured patients. Moreover, the fractured women had a longer diagnosis and were in the postmenopausal period for a longer period than the nonfractured women. The fracture rate was significantly higher in active than in controlled acromegaly (80% versus 33.3%; chi2: 7.6; p=0.008). The patients with active acromegaly who fractured (12 cases) had significantly higher serum IGF-1 values (356 ng/ml; range: 212-950 versus 120 ng/ml; range: 84-217; p<0.001) and T scores (-1.3 SD, range: -2.9 to +1.3 versus -2.7 SD, range: -3.4 to -1.5, p=0.04) compared with the fractured women whose disease was controlled (7 cases). All fractured women with controlled acromegaly had T scores<-1.0 SD (57.1% of them had osteoporosis, and 42.9% were osteopenic). In contrast, 41.7% of women whose fractures were associated with active disease had a normal T score (>-1.0 SD), whereas osteopenia and osteoporosis were found only in 33.3% and 25.0% of them, respectively.
  
  
  CONCLUSIONS
  This cross-sectional study shows that high numbers of postmenopausal women with acromegaly develop vertebral fractures in relation to the activity of disease. Furthermore, our study shows that, in patients with active acromegaly, vertebral fractures occur even in the presence of normal BMD, whereas in patients with controlled acromegaly, vertebral fractures are always accompanied by a pathological BMD.
authors.affiliation: Endocrine Section, Department of Internal Medicine, University of Brescia, Brescia, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bonadonna
authors.forename: Gherardo
authors.initials: G
authors.lastname: Mazziotti
authors.forename: Monica
authors.initials: M
authors.lastname: Nuzzo
authors.forename: Antonio
authors.initials: A
authors.lastname: Bianchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fusco
authors.forename: Laura
authors.initials: L
authors.lastname: De Marinis
authors.forename: Andrea
authors.initials: A
authors.lastname: Giustina
mesh_terms: D000172:Acromegaly / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000097:blood* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging; D017698:Postmenopause / Q000097:blood*; D011237:Predictive Value of Tests; D015995:Prevalence; D011859:Radiography; D012307:Risk Factors; D013124:Spinal Injuries / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers