Mandibular cortical bone alterations in acromegaly: a CBCT-based radiomorphometric and fractal analysis study

Acromegaly is a rare endocrine disorder characterized by chronic excess of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), which can lead to skeletal alterations. This study aimed to evaluate changes in mandibular cortical and trabecular bone in patients with acromegaly using cone beam computed tomography (CBCT) and to investigate their associations with clinical and biochemical parameters.

This retrospective study included CBCT images of 108 individuals: 54 patients with acromegaly (21 females, 33 males) and 54 age- and sex-matched controls. Radiomorphometric indices, including the computed tomography mental index (CTMI), computed tomography mandibular index (CTI), computed tomography cortical index (CTCI), gonial angle (GA), ramus width (RW), ramus height (RH), and articular eminence inclination (AEI), were measured. Trabecular bone structure was assessed using fractal analysis (FA). Correlations between imaging findings and clinical parameters (age, sex, adenoma size, and IGF-1 levels) were analyzed.

Significant differences were observed between patients with acromegaly and controls in CTMI, CTI, RH, and AEI (all p ≤ 0.001), indicating significant differences in mandibular morphology and cortical bone measurements. Trabecular bone changes assessed by FA showed no significant differences between the groups. In the acromegaly group, nominally significant negative correlations were observed between CTMI and age (unadjusted p = 0.024) and between adenoma size and age (unadjusted p = 0.011), while a nominally significant positive correlation was observed between RH and log IGF-1 levels (unadjusted p = 0.021). However, none of these associations remained statistically significant after Benjamini-Hochberg false discovery rate correction for multiple comparisons (all q = 0.192). Significant sex-related differences were observed in GA, RH, FA, and IGF-1 levels (p = 0.013; p < 0.001; p < 0.001; and p = 0.036, respectively).

Acromegaly predominantly affects the cortical bone of the mandible, with limited involvement of trabecular bone. CBCT-derived cortical indices demonstrated significant differences between patients with acromegaly and controls, whereas the observed correlation between RH and log IGF-1 levels did not remain statistically significant after correction for multiple comparisons.