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Bone Disorders01:29

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Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
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The minerals contained in all of the food we consume are essential for our organ systems. However, certain essential minerals, such as calcium, phosphorus, magnesium, manganese, and fluoride, largely affect bone health.
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Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
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Bone Health in Acromegaly.

Maria Francesca Birtolo1, Simona Jaafar1, Giacomo Cristofolini1

  • 1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.

Endocrinology and Metabolism Clinics of North America
|October 23, 2025
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Summary

Skeletal fragility in acromegaly, caused by excess growth hormone (GH), leads to weak bones and fractures. Current treatments struggle to fully restore bone health, posing management challenges.

Keywords:
AcromegalyArthropathyBoneOsteopathyOsteoporosisVertebral fractures

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Area of Science:

  • Endocrinology
  • Bone Biology
  • Metabolic Diseases

Background:

  • Acromegaly, characterized by excess growth hormone (GH) and insulin-like growth factor-1 (IGF-1), significantly impacts bone health.
  • Altered bone remodeling in acromegaly leads to microstructural deterioration and reduced bone strength, increasing vertebral fracture risk.
  • Skeletal fragility in acromegaly presents management challenges due to difficulties in fracture prediction and incomplete bone structure restoration with current therapies.

Purpose of the Study:

  • To review the emerging pathophysiologic mechanisms of acromegalic osteopathy.
  • To discuss the clinical manifestations and diagnostic challenges of skeletal fragility in acromegaly.
  • To explore current and potential therapeutic strategies for managing bone complications in acromegaly.

Main Methods:

  • Literature review of pathophysiologic, clinical, and therapeutic aspects of acromegalic osteopathy.
  • Analysis of studies on bone remodeling, microstructure, and fracture risk in acromegaly.
  • Evaluation of the efficacy of existing and novel treatments for skeletal complications.

Main Results:

  • Hypersecretion of GH and IGF-1 drives altered bone remodeling, compromising bone strength.
  • Biochemical control of GH excess often fails to normalize bone microarchitecture.
  • The efficacy of bone-active drugs in acromegaly remains largely unestablished, highlighting a therapeutic gap.

Conclusions:

  • Acromegalic osteopathy is a complex skeletal complication requiring a deeper understanding of its pathophysiology.
  • Effective management strategies are needed to address fracture risk and improve bone quality in acromegaly patients.
  • Further research into bone-specific therapies is crucial for improving skeletal outcomes in acromegaly.