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.
Key words
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
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