Bone material strength index as measured by impact microindentation is altered in patients with acromegaly
Bone material strength index as measured by impact microindentation is altered in patients with acromegaly
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DOI：
10.1530/eje-16-0808
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发表时间：
2017-03-01
影响因子：
5.8
通讯作者：
Appelman-Dijkstra, N. M.
中科院分区：
文献类型：
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作者：
Malgo, F.;Hamdy, N. A. T.;Appelman-Dijkstra, N. M.
目的：肢端肥大症是一种罕见的疾病，由垂体腺瘤分泌过多的生长激素引起。GH和IGF-1过量的骨骼并发症包括骨转换增加、皮质骨量增加和骨小梁微结构恶化，在相对正常的骨密度(BMD)存在时，与脊柱骨折的风险相关。我们的目标是用冲击式微压痕(IMI)评估控制良好的18岁肢端肥大症患者和来自骨质量中心门诊的44名对照组的骨组织水平特性。设计和方法：在这项横断面研究中，使用骨探头测量48例肢端肥大症患者和44名对照组的骨材料强度指数(BMSi)。结果：肢端肥大症患者(54%男性)的平均年龄为60.2岁(37.9-76.5岁)，对照组为60.5岁(39.8-78.6岁)(50%男性)。肢端肥大症患者和对照组的体重指数(28.2 kg/m(2)+/-4.7vs 26.6 kg/m(2)+/-4.3，P=0.087)和腰椎(1.04g/cm(2)+/-0.21vs 1.03g/cm(2)+/-0.13，P=0.850)和股骨颈(0.84g/cm(2)+/-0.16vs0.80g/cm(2)+/-0.09，P=0.246)。肢端肥大症患者的BMSI显著低于对照组(79.4+/-0.7vs83.2+/-0.7；P<；0.001)。结论：我们的数据表明，控制性肢端肥大症患者在长期暴露于病理性高水平的生长激素和胰岛素样生长因子-1后，皮质骨的组织水平发生了显著变化。我们的研究结果还表明，应该考虑使用DXA以外的其他方法来评估肢端肥大症患者的骨脆性。
Objective: Acromegaly is a rare disease caused by excess growth hormone (GH) production by the pituitary adenoma. The skeletal complications of GH and IGF-1 excess include increased bone turnover, increased cortical bone mass and deteriorated microarchitecture of trabecular bone, associated with a high risk of vertebral fractures in the presence of relatively normal bone mineral density (BMD). We aimed to evaluate tissue-level properties of bone using impact microindentation (IMI) in well-controlled patients with acromegaly aged >= 18 years compared to 44 controls from the outpatient clinic of the Centre for Bone Quality.Design and methods: In this cross-sectional study, bone material strength index (BMSi) was measured in 48 acromegaly patients and 44 controls with impact microindentation using the osteoprobe. Results: Mean age of acromegaly patients (54% male) was 60.2 years (range 37.9-76.5), and 60.5 years (range 39.8-78.6) in controls (50% male). Patients with acromegaly and control patients had comparable BMI (28.2 kg/m(2) +/- 4.7 vs 26.6 kg/ m(2) +/- 4.3, P = 0.087) and comparable BMD at the lumbar spine (1.04 g/cm(2) +/- 0.21 vs 1.03 g/cm(2) +/- 0.13, P = 0.850) and at the femoral neck (0.84 g/cm(2) +/- 0.16 vs 0.80 g/cm(2) +/- 0.09, P = 0.246). BMSi was significantly lower in acromegaly patients than that in controls (79.4 +/- 0.7 vs 83.2 +/- 0.7; P < 0.001).Conclusion: Our data indicates that tissue-level properties of cortical bone are significantly altered in patients with controlled acromegaly after reversal of long-term exposure to pathologically high GH and IGF-1 levels. Our findings also suggest that methods other than DXA should be considered to evaluate bone fragility in patients with acromegaly.