The acromegalic spine: fractures, deformities and spinopelvic balance
- 51 Downloads
Axial skeleton arthropathy and osteoporotic vertebral fractures are common findings in acromegalic patients and can result in severe spinal deformity.
To investigate the presence of spinal fractures and deformities, sagittal imbalances, and spinopelvic compensatory mechanisms in acromegalics.
Patients and methods
58 patients with acromegaly from a referral neuroendocrinology center were prospectively evaluated by panoramic spine radiographs to detect the presence of fractures and scoliosis, to measure thoracic kyphosis, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sagittal vertical axis (SVA). Sagittal imbalance criteria were considered: thoracic kyphosis > 50°, PI-LL > 10°, PT > 20° and SVA > 5 cm. Their medical records were analyzed for clinical and laboratorial data.
The prevalence of fractures was 13.8%, predominantly in the thoracic spine, with mild and anterior wedge compressions. Scoliosis was present in 34.5% of the cases, all with degenerative lumbar curve apex. Thoracic kyphosis > 50º occurred in 36.8% of patients, PI-LL > 10° in 48.3%, PT > 20° in 41.4% and SVA > 5 cm in 12.1%.
Increased number of vertebral fractures and high prevalence of spinal deformities related to sagittal imbalance were detected, indicating the importance of monitoring bone comorbidities in acromegaly, with radiological evaluation of the spine as part of the follow up.
KeywordsAcromegaly Spinal column Osteoporotic fractures Sagittal balance kyphosis
No funding has been received for this project.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest for this project.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The project was approved by the institution's Research Ethics Committee.
Informed consent was obtained from all individual participants included in the study.
- 1.Mestron A, Webb SM, Astorga R, Benito P, Catala M, Gaztambide S, Gomez JM, Halperin I, Lucas-Morante T, Moreno B, Obiols G, de Pablos P, Paramo C, Pico A, Torres E, Varela C, Vazquez JA, Zamora J, Albareda M, Gilabert M (2004) Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Español de Acromegalia, REA). Eur J Endocrinol 151:439–446CrossRefGoogle Scholar
- 5.Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, Strasburger CJ, Luger A, Clemmons DR, Giustina A (2018) A consensus statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol 14(9):552–561. https://doi.org/10.1038/s41574-018-0058-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Cobb JR (1948) The American Academy of Orthopedic Surgeons Instructional Course Lectures, vol 5. Edwards, Ann Arbor, MIGoogle Scholar
- 9.Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V (2012) Scoliosis research society—Schwab adult spinal deformity classification: a validation study. Spine 37(12):1077–1082. https://doi.org/10.1097/BRS.0b013e31823e15e2 CrossRefPubMedGoogle Scholar
- 10.Yang C, Yang M, Chen Y, Wei X, Ni H, Chen Z, Li J, Bai Y, Zhu X, Li M (2015) Radiographic parameters in adult degenerative scoliosis and different parameters between sagittal balanced and imbalanced ADS patients. Medicine 94(29):e1198. https://doi.org/10.1097/MD.0000000000001198 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Losa M, Von Werder K (1997) Pathophysiology and clinical aspects of the ectopic GH-releasing hormone syndrome. Clin Endocrinol 47(2):123–135. https://doi.org/10.1046/j.1365-2265.1997.2311048.x CrossRefGoogle Scholar
- 12.Banerjee A, Patel K, Wren AM (2003) Acromegaly—clinical manifestations and diagnosis. Pharm J 13:273–278Google Scholar
- 17.Mercado M, Gonzalez B, Vargas G, Ramirez C, de los Monteros ALE, Sosa E, Jervis P, Roldan P, Mendoza V, López-Félix B, Guinto G, (2014) Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. J Clin Endocrinol Metab 99(12):4438–4446. https://doi.org/10.1210/jc.2014-2670 CrossRefPubMedGoogle Scholar
- 21.Abu Dabrh AM, Mohammed K, Asi N, Farah WH, Wang Z, Farah MH, Prokop LJ, Katznelson L, Murad MH (2014) Surgical interventions and medical treatments in treatment-naïve patients with acromegaly. J Clin Endocrinol Metab 99(11):4003–4014. https://doi.org/10.1210/jc.2014-2900 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Maione L, Brue T, Beckers A, Delemer B, Petrossians P, Borson-Chazot F, Chabre O, François P, Bertherat J, Cortet-Rudelli C, Chanson P (2017) French Acromegaly Registry Group. Changes in the management and comorbidities of acromegaly over three decades: the French Acromegaly Registry. Eur J Endocrinol 176(5), 645–655 Doi: 10.1530/EJE-16-1064.CrossRefGoogle Scholar
- 25.Bonadonna S, Mazziotti G, Nuzzo M, Bianchi A, Fusco A, De Marinis L, Giustina A (2005) Increased prevalence of radiological spinal deformities in active acromegaly: a cross-sectional study in postmenopausal women. J Bone Miner Res 20(10):1837–1844. https://doi.org/10.1359/JBMR.050603 CrossRefPubMedGoogle Scholar
- 29.Madeira M, Neto LV, de Paula Paranhos Neto F, Barbosa Lima IC, Carvalho de Mendonça LM, Gadelha MR, Fleiuss de Farias ML, (2013) Acromegaly has a negative influence on trabecular bone, but not on cortical bone, as assessed by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab 98(4):1734–1741. https://doi.org/10.1210/jc.2012-4073 CrossRefPubMedGoogle Scholar
- 30.Mazziotti G, Bianchi A, Porcelli T, Mormando M, Maffezzoni F, Cristiano A, Giampietro A, De Marinis L, Giustina A (2013) Vertebral fractures in patients with acromegaly: a 3-year prospective study. J Clin Endocrinol Metab 98(8):3402–3410. https://doi.org/10.1210/jc.2013-1460 CrossRefPubMedGoogle Scholar
- 31.Claessen KM, Kroon HM, Pereira AM, Appelman-Dijkstra NM, Verstegen MJ, Kloppenburg M, Hamdy NA, Biermasz NR (2013) Progression of vertebral fractures despite long-term biochemical control of acromegaly: a prospective follow-up study. J Clin Endocrinol Metab 98(12):4808–4815. https://doi.org/10.1210/jc.2013-2695 CrossRefPubMedGoogle Scholar
- 34.Chiloiro S, Mazziotti G, Giampietro A, Bianchi A, Frara S, Mormando M, Pontecorvi A, Giustina A, De Marinis L (2018) Effects of pegvisomant and somatostatin receptor ligands on incidence of vertebral fractures in patients with acromegaly. Pituitary 21(3):302–308. https://doi.org/10.1007/s11102-018-0873-7 CrossRefPubMedGoogle Scholar
- 40.Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 14(5), 821–828 Doi: 10.1359/jbmr.1922.214.171.1241.CrossRefGoogle Scholar