Vertebral fracture risk increased for adults with acromegaly, high growth hormone levels
Adults with acromegaly are more likely to experience a vertebral fracture than those without the disease, and high growth hormone levels increase fracture risk, according to study data from Italy.
“Vertebral fractures are a relatively early complication of acromegaly, being already very frequent in one-third of acromegaly patients undergoing neurosurgery within 1 year of the diagnosis,” Andrea Giustina, MD, professor of endocrinology at University Vita-Salute San Raffaele and head of the endocrinology division at IRCCS San Raffaele Hospital in Milan, told Healio. “Growth hormone levels and therefore activity of the disease is a good predictor of vertebral fracture risk in acromegaly.”
Giustina and colleagues analyzed data from 92 adults with acromegaly who had transsphenoidal surgery at IRCCS San Raffaele Hospital from 2009 to 2020 (53.2% women; mean age, 50.7 years). Participants who had fasting blood samples collected at admission and medical history available were included in the study. The acromegaly group was compared with a retrospectively selected control group of 85 adults admitted to IRCCS San Raffaele Hospital for acute lower respiratory tract infections in 2019 (43.5% women; mean age, 54.8 years). Lateral chest X-rays were performed to detect vertebral fractures in all participants.
The findings were published in The Journal of Clinical Endocrinology & Metabolism.
A higher percentage of adults with acromegaly sustained a vertebral fracture compared with the control group (33.7% vs. 12.9%; P = .001). There was no significant difference between the two groups in the proportion of adults sustaining multiple fractures.
Among those with acromegaly who had a vertebral fracture, 38.7% sustained multiple fractures and 16.1% had a moderate or severe fracture. There were no differences in fracture risk by age, sex, menopausal status, male hypogonadism, hypopituitarism or adrenal insufficiency. Those with acromegaly and a vertebral fracture had higher serum GH levels than those without fracture (12.1 ng/mL vs. 8.1 ng/mL; P = .03).
“GH levels were more detrimentally impactful on bone than insulin-like growth factor I levels,” Giustina said. “This may be related to the potentially negative skeletal effects of GH itself.”
Having a higher GH level at acromegaly diagnosis independently increased the risk for vertebral fractures (OR = 1.047; 95% CI, 1.003-1.093; P = .003). The cutoff value of serum GH that predicted an increased risk for vertebral fractures was 12 ng/mL, with 73.7% sensitivity and 53.3% specificity.
“Early diagnosis and effective treatment of acromegaly are crucial for preventing vertebral fractures since it is likely this complication may be effectively impacted by reducing the diagnostic delay of the disease,” Giustina said. “Controlling growth hormone levels in acromegaly appears to be relevant to the prevention of skeletal complications. Vertebral fractures assessment, based on our findings, should be performed in all patients with acromegaly at diagnosis and particularly in those with marked GH elevation.”
For more information:
Andrea Giustina, MD, can be reached at firstname.lastname@example.org.