title: Fractures in pituitary adenoma patients from the Dutch National Registry of Growth Hormone Treatment in Adults.
abstract: OBJECTIVE
  The effects of growth hormone (GH) replacement therapy on fracture risk in adult GH deficient (GHD) patients with different etiologies of pituitary GHD are not well known, due to limited data. The aim of this study was to investigate characteristics and fracture occurrence at start of (baseline) and during long-term GH replacement therapy in GHD adults previously treated for Cushing's disease (CD) or acromegaly, compared to patients with previous nonfunctioning pituitary adenoma (NFPA).
  
  
  METHODS
  From the Dutch National Registry of Growth Hormone Treatment in Adults, a nationwide surveillance study in severe GHD adults, all patients using ≥30 days of GH replacement therapy with previous NFPA (n = 783), CD (n = 180) and acromegaly (n = 65) were selected. Patient characteristics, fractures and potential influencing factors were investigated.
  
  
  RESULTS
  At baseline, patients with previous CD were younger, more often female and had more often a history of osteopenia or osteoporosis, whereas patients with previous acromegaly had more often received cranial radiotherapy and a longer duration between treatment of their pituitary tumor and start of adult GH replacement therapy. During follow-up, a fracture occurred in 3.8 % (n = 39) of all patients. Compared to patients with previous NFPA, only patients with previous acromegaly had an increased fracture risk after 6 years of GH replacement therapy.
  
  
  CONCLUSIONS
  During GH replacement therapy, an increased fracture risk was observed in severe GHD adult patients previously treated for acromegaly, but not in those previously treated for CD, compared to severe GHD adult patients using GH replacement therapy because of previous NFPA. Further studies are needed to confirm these findings and to elucidate potential underlying mechanisms.
authors.affiliation: Department of Internal Medicine, Endocrine section, Neuroscience Campus Amsterdam, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. nc.vanvarsseveld@vumc.nl.
authors.forename: N C
authors.initials: NC
authors.lastname: van Varsseveld
authors.affiliation: Department of Internal Medicine, Endocrine section, Neuroscience Campus Amsterdam, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: C C
authors.initials: CC
authors.lastname: van Bunderen
authors.affiliation: Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands.
authors.forename: A A M
authors.initials: AA
authors.lastname: Franken
authors.affiliation: Emotional Brain and Alan Turing Institute for Multidisciplinary Health Research, Almere, The Netherlands.
authors.forename: H P F
authors.initials: HP
authors.lastname: Koppeschaar
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Lely
authors.affiliation: Department of Internal Medicine, Endocrine section, Neuroscience Campus Amsterdam, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Drent
mesh_terms: D015502:Absorptiometry, Photon; D000236:Adenoma / Q000628:therapy; D000328:Adult; D000368:Aged; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000453:epidemiology; D016371:Cranial Irradiation; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D013006:Growth Hormone / Q000172:deficiency; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000628:therapy; D020249:Hormone Replacement Therapy / Q000379:methods*; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D047748:Pituitary ACTH Hypersecretion / Q000628:therapy; D010902:Pituitary Gland / Q000601:surgery; D010911:Pituitary Neoplasms / Q000628:therapy; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone; D013006:Growth Hormone
keywords: Acromegaly; Bone; Cushing’s disease; Fractures; Growth hormone; Growth hormone deficiency; Nonfunctioning pituitary adenoma