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

Area of Science:

• Endocrinology
• Bone Metabolism
• Rheumatology

Background:

• Acromegaly is associated with increased vertebral fracture risk due to diminished bone quality, independent of bone mineral density (BMD).
• Bone microarchitecture assessment is crucial for understanding fracture risk in acromegaly.

Purpose of the Study:

• To evaluate bone quality in acromegaly patients using trabecular bone score (TBS).
• To compare bone microarchitecture between newly diagnosed acromegaly patients and healthy controls.
• To assess the impact of normalized insulin-like growth factor 1 (IGF-1) on bone quality and turnover.

Main Methods:

• Recruited 18 newly diagnosed acromegaly patients and 36 age/sex-matched controls.
• Assessed pituitary function, bone/calcium-phosphorous metabolism, BMD, and TBS via dual-energy x-ray absorptiometry.
• Collected data at diagnosis and 12 months post-IGF-1 normalization.

Main Results:

• Acromegaly patients had significantly lower TBS (1.20±0.13 vs 1.30±0.06) and higher bone turnover markers (CTX, osteocalcin) compared to controls.
• BMD and vertebral fracture prevalence were similar between groups at diagnosis.
• Surgically cured patients showed greater reduction in bone turnover markers (osteocalcin, CTX) after 1 year compared to medically treated patients; however, TBS and BMD remained unchanged.

Conclusions:

• Acromegaly patients exhibit impaired bone quality (lower TBS) despite normal BMD.
• Normalization of growth hormone secretion rapidly normalizes bone turnover.
• TBS may serve as a valuable tool for assessing bone microarchitecture in acromegaly.