Persistent Deficits in Bone Quality in Treated Acromegaly: Evidence From Assessments of Microstructure

Area of Science:

• Endocrinology
• Bone Biology
• Metabolic Diseases

Background:

• Acromegaly is associated with increased fracture risk, both before and after treatment.
• Bone microstructure abnormalities in active acromegaly may explain this fragility.
• The long-term effects of acromegaly treatment on bone quality are not fully understood.

Purpose of the Study:

• To investigate the impact of acromegaly treatment and remission on bone quality.
• To determine if bone microstructure abnormalities improve with treatment or persist after biochemical remission.

Main Methods:

• Studied 65 patients with acromegaly longitudinally and cross-sectionally.
• Assessed bone mineral density (DXA), trabecular bone score (TBS), and high-resolution peripheral quantitative tomography (HR-pQCT) of radius and tibia.
• Compared treated patients to sex-, age-, and BMI-matched healthy controls.

Main Results:

• Acromegaly treatment improved bone density, stiffness, and strength in the radius and tibia.
• Patients in remission had larger bones but lower volumetric bone density and disrupted microarchitecture compared to controls.
• Trabecular bone score (TBS) did not change with treatment but correlated with microstructural parameters.

Conclusions:

• Bone density and microarchitecture improve with acromegaly treatment but remain abnormal in remission.
• These persistent abnormalities may contribute to the increased fracture risk in treated acromegaly patients.
• Further research is needed to understand and manage persistent bone fragility in acromegaly.