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Musculoskeletal disease in acromegaly-a population-based registry study
Christian Rosendal1, Mai Christiansen Arlien-Søborg2, Eigil Husted Nielsen1
1Department of Endocrinology, Aalborg University Hospital, 9000 Aalborg, Denmark.
Insights
Acromegaly patients face higher risks of osteoarthritis and osteoporosis, even before diagnosis. This condition also increases the need for musculoskeletal surgery, including joint replacements, and pain medication.
Area of Science:
- Endocrinology
- Rheumatology
- Orthopedics
Background:
- Acromegaly, a disorder caused by excess growth hormone, is linked to significant musculoskeletal issues impacting patient quality of life and work capacity.
- Understanding these complications is crucial for comprehensive patient management.
Purpose of the Study:
- To investigate the risks of osteoarthritis, osteoporosis, fractures, and analgesic use in Danish individuals with acromegaly.
- To assess the incidence of musculoskeletal surgeries, including joint replacements, in this patient cohort.
Main Methods:
- A national, registry-based cohort study was conducted from 1977 to 2021.
- 844 acromegaly patients were matched with 1:100 healthy controls.
- Cox regression and Kaplan-Meier analyses were used to evaluate outcomes.
Main Results:
- Acromegaly patients showed significantly elevated risks for shoulder, hip, and knee osteoarthritis, as well as medically treated osteoporosis, even preceding acromegaly diagnosis.
- The risk of shoulder, hip, and knee replacement surgery was notably higher in acromegaly patients.
- Increased likelihood of requiring weak analgesics or opioids, alongside a higher risk of surgical complications and repeat hip surgery, was observed.
Conclusions:
- Severe, progressive osteoarthritis and medically treated osteoporosis are significant concerns in acromegaly, manifesting even before diagnosis and persisting post-treatment.
- Acromegaly patients have an increased risk of various musculoskeletal surgeries, particularly joint replacements, and require more analgesic medication.
- Further research is recommended to optimize the management of musculoskeletal complications in acromegaly patients.
Objective:
Acromegaly is associated with multiple musculoskeletal complications that affect the quality of life and work ability. We aimed to examine the risk of osteoarthritis, musculoskeletal surgery (including joint replacement), osteoporosis, fractures, and analgesic consumption in Danish acromegaly patients.
Design:
National, registry-based cohort study.
Methods:
All validated incidents and prevalent cases of acromegaly in the period 1977-2021 (n = 844) were included and matched 1:100 with healthy controls. Outcomes were identified using diagnosis, surgical procedure, and medication codes and analyzed using Cox regression and Kaplan-Meier plots.
Results:
Patients were at significantly increased risk of osteoarthritis of the shoulder [hazard ratio (HR): 5.25 (3.05; 9.06)], hip [HR: 3.15 (2.57; 3.87)], and knee [HR: 2.25 (1.85; 2.72)], and medically treated osteoporosis [HR: 2.13 (1.64; 2.78)] even before acromegaly diagnosis. The risk of joint replacement surgery of the shoulder [HR: 4.60 (2.57; 8.25)], hip [HR: 3.32 (2.67; 4.12)], and knee [HR: 2.52 (1.89; 3.36)] was increased in acromegaly patients, as was the risk of being prescribed weak analgesics [HR: 1.22 (1.04; 1.44)] or opioids [HR: 1.58 (1.38; 1.82)]. Surgical complications [HR: 2.19 (1.59; 3.03)] and repeat hip surgery [HR: 3.64 (2.09; 6.34)] also exhibited increased risk in patients.
Conclusion:
In acromegaly, severe osteoarthritis involving multiple joints develops even before acromegaly diagnosis and continues to progress over time after acromegaly treatment. Furthermore, acromegaly imposes an increased risk of medically treated osteoporosis, musculoskeletal surgery-particularly joint replacement surgery-, surgical complications, and the necessity of analgesic medication. Our findings warrant further research into the management of musculoskeletal disease in acromegaly.
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