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Bone mineral density, turnover, and microarchitecture assessed by second-generation high-resolution peripheral quantitative computed tomography in patients with Sheehan’s syndrome

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Abstract

Summary

Sheehan’s syndrome (SS) is a rare but well-characterized cause of hypopituitarism. Data on skeletal health is limited and on microarchitecture is lacking in SS patients.

Purpose

We aimed to explore skeletal health in SS with bone mineral density (BMD), turnover, and microarchitecture.

Methods

Thirty-five patients with SS on stable replacement therapy for respective hormone deficiencies and 35 age- and BMI-matched controls were recruited. Hormonal profile and bone turnover markers (BTMs) were measured using electrochemiluminescence assay. Areal BMD and trabecular bone score were evaluated using DXA. Bone microarchitecture was assessed using a second-generation high-resolution peripheral quantitative computed tomography.

Results

The mean age of the patients was 45.5 ± 9.3 years with a lag of 8.3 ± 7.2 years prior to diagnosis. Patients were on glucocorticoid (94%), levothyroxine (94%), and estrogen–progestin replacement (58%). None had received prior growth hormone (GH) replacement. BTMs (P1NP and CTX) were not significantly different between patients and controls. Osteoporosis (26% vs. 16%, p = 0.01) and osteopenia (52% vs. 39%, p = 0.007) at the lumbar spine and femoral neck (osteoporosis, 23% vs. 10%, p = 0.001; osteopenia, 58% vs. 29%, p = 0.001) were present in greater proportion in SS patients than matched controls. Bone microarchitecture analysis revealed significantly lower cortical volumetric BMD (vBMD) (p = 0.02) at the tibia, with relative preservation of the other parameters.

Conclusion

Low areal BMD (aBMD) is highly prevalent in SS as compared to age- and BMI-matched controls. However, there were no significant differences in bone microarchitectural measurements, except for tibial cortical vBMD, which was lower in adequately treated SS patients.

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Data Availability

The data that support the findings of this study are available on reasonable request from the corresponding author.

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Acknowledgements

We wish to acknowledge Mr. Nipun Chawla and Mr. Raman Saini for helping in the HRpQCT data acquisition.

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Authors and Affiliations

  1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Liza Das, Vandana Dhiman, Sanjay Kumar Bhadada & Pinaki Dutta

  2. Department of Telemedicine, PGIMER, Chandigarh, India

    Liza Das

  3. Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India

    Bashir Ahmad Laway

  4. Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India

    Jayaprakash Sahoo

  5. Department of Radiology, PGIMER, Chandigarh, India

    Paramjeet Singh

  6. Division of Endocrinology, Metabolism and Bone and Mineral Disorders, and Bone and Mineral Research Laboratory, Henry Ford Health, Detroit, MI, USA

    Sudhaker Dhanwada Rao

  7. Michigan State University College of Human Medicine, East Lansing, MI, USA

    Sudhaker Dhanwada Rao

  8. Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK

    Márta Korbonits

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  1. Liza Das
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Correspondence to Sanjay Kumar Bhadada or Pinaki Dutta.

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Das, L., Laway, B.A., Sahoo, J. et al. Bone mineral density, turnover, and microarchitecture assessed by second-generation high-resolution peripheral quantitative computed tomography in patients with Sheehan’s syndrome. Osteoporos Int 35, 919–927 (2024). https://doi.org/10.1007/s00198-024-07062-z

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