Factors Associated with Bone Metabolism in Acromegalic Patients: Hypogonadism and Female Gender

Abstract

The purpose of the study was to determine the factors associated with bone metabolism in acromegalic patients. Thirty three patients with acromegaly who had been followed on a regular basis in the endocrinology clinic were enrolled for the study. Among the factors acting upon bone metabolism, age, gender, body mass index (BMI), duration and activity of the disease, length of remission, treatment modalities and functional status of the pituitary were evaluated. Their influences on the determinants of bone remodelling and bone mineral density (BMD) were tried to be elucidated. The median age of the 33 acromegalics (19 females, 14 males) was 39.73 ± 10.1 years. Twenty-three patients (9 males and 14 females) were eugonadal. Ten patients had been diagnosed with history of at least one year of untreated hypogonadism (5 males and 5 females; for 1 - 10 years). The BMD values of the lumbar vertebrae, the femur and the radius were correlated with each other. Patients were grouped according to their T-scores as decreased, normal, and increased BMD. Groups were similar with regard to age, BMI, gender, duration of disease, and remission, GH, IGF-1, IGFBP-3 levels, markers of bone turnover. Presence of hypogonadism and duration of hypogonadism revealed statistically significant difference among the 3 groups (p = 0.005 and p = 0.035, respectively). Hypogonadal acromegalic patients had decreased BMD compared to eugonadal acromegalics and healthy population while the eugonadal female acromegalic patients revealed increased BMD of lumbar vertebrae, femur, and distal radius compared to the sex-matched healthy population.

Acromegaly - bone mineral density - gender - femur - radius - spine

References

• 1 Andreassen T, Oxlund H. Additive anabolic effects of growth hormone and parathyroid hormone on vertebral body cortical and cancellous bone in old ovariectomized rats.  J Bone Miner Res. 1996;  11 (Suppl 1) S457
• 2 Barkan A L. Acromegaly. Diagnosis and therapy.  Endocinol Metab Clin North Am. 1989;  18 277-310
• 3 Bikle D D, Harris J, Halloran B P, Currier P A, Tanner S, Morey-Holton E. The molecular response of bone to growth hormone during skeletal unloading: regional differences.  Endocrinology. 1995;  136 2099-2109
• 4 Deplewski D, Rosenfield R L. Growth hormone and insulin-like growth factors have different effects on sebaceous cell growth and differentiation.  Endocrinology. 1999;  140 4089-4094
• 5 Diamond T, Nery L, Posen S. Spinal and peripheral bone mineral densities in acromegaly: the effects of excess growth hormone and hypogonadism.  Ann Intern Med. 1989;  111 567-573
• 6 Escobar-Morreale H F, Serrano-Gotarredona J, Garcia-Robles R, Varela C, Sancho J M. Abnormalities in the serum insulin-like growth factor-1 axis in women with hyperandrogenism.  Fertil Steril. 1998;  70 1090-1100
• 7 Ezzat S, Melmed S, Endres D, Eyre D R, Singer F R. Biochemical assessment of bone formation and resorption in acromegaly.  J Clin Endocrinol Metab. 1993;  76 1452-1457
• 8 Fredstorp L, Pernow Y, Werner S. The short and long term effects of octreotide on calcium homeostasis in patients with acromegaly.  Clin Endocrinol. 1993;  39 331-336
• 9 Gurlek A, Bayraktar M, Ariyürek M. Inappropriate reference range for peak bone mineral density in dual-energy X-ray absorptiometry: implications for the interpretation of T-scores.  Osteoporos Int. 2000;  11 809-813
• 10 Ho P J, Fig L M, Barkan A L, Shapiro B. Bone mineral density of the axial skeleton in acromegaly.  J Nucl Med. 1992;  33 1608-1612
• 11 Kayath M J, Vieira J GH. Osteopenia occurs in a minority of patients with acromegaly and is predominant in the spine.  Osteoporosis Int. 1997;  7 226-230
• 12 Kotzmann H, Bernecker P, Hubsch P, Pietschmann P, Woloszczuk W, Svoboda T, Geyer G, Luger A. Bone mineral density and parameters of bone metabolism in patients with acromegaly.  J Bone Miner Res. 1993;  8 459-465
• 13 Lesse G P, Fraser W D, Farquharson R, Hipkin L, Vora J P. Gonadal status is an important determinant of bone density in acromegaly.  Clinical Endocrinology. 1998;  48 59-65
• 14 Ohlsson C, Bengtsson B, Isaksson O GP, Andreassen T T, Slootweg M C. Growth hormone and bone.  Endocr Rev. 1998;  19 55-79
• 15 Orhii P, Noland K, Rutstein J, Kalu D. Effect of growth hormone therapy on cancellous bone in aged ovariectomized rats.  J Bone Miner Res. 1996;  11 (Suppl 1) S458
• 16 Piedra C, Larranaga E CJ, Castro N, Horcajada C, Rapado A, Pombo J LH. Correlation among plasma osteocalcin, growth hormone, and somatomedin C in acromegaly.  Calcif Tissue Int. 1988;  43 44-45
• 17 Ueland T, Bollerslev J, Hansen T B, Ebbesen E N, Mosekilde L, Brixen K, Flyvbjerg A, Djoseland O. Increased cortical bone content of insulin-like growth factors in acromegalic patients.  J Clin Endocrinol Metab. 1999;  84 123-127
• 18 Vanderschueren D, Boonen S, Bouıllon R. Action of androgens versus estrogens in male skeletal homeostasis.  Bone. 1998;  23 391-394