Morphometric Vertebral Fractures in “Difficult” Patients with Acromegaly

Presentation Number: SUN 457
Date of Presentation: April 2nd, 2017

Sabrina Chiloiro*1, Marilda Mormando1, Antonella Giampietro1, Antonio Bianchi1, Domenico Milardi1, Anna Maria Formenti2, Maria elena Bracaccia1, Giuseppe Grande1, Chiara Bima1, Serena Piacentini1, Linda Tartaglione1, Alfredo Pontecorvi3, Andrea Giustina2 and Laura De Marinis4
1Catholic University of the Sacred Heart, Rome, Italy, 2University of Brescia, Italy, 3Catholic University, School of Medicine, Rome, Italy, 4Università Cattolica del Sacro Cuore, Rome, Italy


Introduction: The increased prevalence of vertebral fractures (VF) in acromegaly is associated with biochemically active disease, expression of the exon 3-deleted isoform of GH receptor and coexisting hypogonadism. Pegvisomant treatment has been reported be associated with an increase risk of incident fractures despite improving bone turn-over and BMD. This has been associated with the use of Pegvisomant in the difficult patients who required multimodal treatment of the disease and for this reason were with Pegvisomant treatment.

Subjects and methods: A cross-sectional study was designed to investigate factors influencing the fracture risk in patients with not controlled acromegaly and for this reason Pegvisomant treatment. All patients were evaluated for VFs and bone mineral density at lumbar spine and hip. Serum IGF1 levels and GHR genotype were assessed.

Results: In males, 10 out of 13 patients were controlled for acromegaly. 6 patients with VF were detected (46.1%). Hypogonadal patients showed a higher risk of VF, as compared to eugonadal patients (p=0.02; OR: 30 95%IC:1.4-611.8). VF risk was not increased in uncontrolled patients. In females, 20 patients out of 25 were controlled for acromegaly. 6 patients with VF were detected (24%). Higher frequency of VF was identified in biochemically active acromegaly (p=0.03).

Conclusion: In our acromegaly “difficult” patients, our finding suggest that in females the VF risk is influenced only from the biochemical status of acromegaly. Instead in males, hypogonadism is the strongest factor influencing VF events. Further studies with larger series of similar patient are necessary to confirm these findings.


Disclosure: AG: Ad Hoc Consultant, Pfizer, Inc., Ad Hoc Consultant, Novartis Pharmaceuticals, Ad Hoc Consultant, Ipsen. Nothing to Disclose: SC, MM, AG, AB, DM, AMF, MEB, GG, CB, SP, LT, AP, LD