Journal of Bone and Mineral Metabolism

, Volume 24, Issue 1, pp 72–78

Bone mineral density and turnover in patients with acromegaly in relation to sex, disease activity, and gonadal function

  • Marek Bolanowski
  • Jacek Daroszewski
  • Marek Mędraś
  • Beata Zadrożna-Śliwka
ORIGINAL ARTICLE

Abstract

Acromegaly is a rare disease caused by growth hormone (GH) hypersecretion. GH and insulin-like growth factor-I (IGF-I) exert anabolic activity in bones. Nevertheless, bone mineral density (BMD) loss is not uncommon in patients with acromegaly. It is assumed to be due to hypogonadism associated with the acromegaly. The aim of the study was to examine BMD at various skeletal sites and bone turnover and to assess the influence of impaired gonadal function and disease activity on BMD and turnover changes in acromegaly. A total of 62 patients were studied (40 women, 22 men). Among the women, 22 had active disease and 18 were cured; 16 women had normal gonadal function, and 24 were hypogonadal. Altogether, 12 men presented with active acromegaly, and 10 were cured; normal gonadal function was found in 10 men, and hypogonadism was diagnosed in 12 men. Controls were 30 healthy subjects. Densitometry using dual-energy X-ray absorptiometry of the lumbar spine, proximal femur, forearm, and total body was carried out. Bone turnover was studied based on serum osteocalcin, C-terminal collagen type 1 crosslinks, and bone alkaline phosphatase concentration. A disadvantageous effect of acromegaly on bone density was associated with hypogonadism in the distal radius (in women), the proximal femur (in men), and the total body (both sexes). An anabolic effect of GH during active acromegaly was present in the proximal femur only in men. We confirmed increased bone turnover in the presence of acromegaly, and these changes were similar regarding the activity of the disease and the gonadal status.

Key words

acromegaly bone mineral density bone turnover dual-energy X-ray absorptiometry (DXA) hypogonadism 

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References

  1. 1.
    Ho, PJ, Fig, LM, Barkan, AL, Shapiro, B 1992Bone mineral density of the axial skeleton in acromegalyJ Nucl Med3316081612PubMedGoogle Scholar
  2. 2.
    Jockenhovel, F, Rohrbach, S, Deggerich, S, Reinwein, D, Reiners, C 1996Differential presentation of cortical and trabecular peripheral bone mineral density in acromegalyEur J Med Res1377382PubMedGoogle Scholar
  3. 3.
    Diamond, T, Nery, L, Posen, S 1989Spinal and peripheral bone mineral densities in acromegaly: the effects of excess growth hormone and hypogonadismAnn Intern Med111567573PubMedGoogle Scholar
  4. 4.
    Scillitani, A, Chiodini, I, Carnevale, V, Giannatempo, GM, Frusciante, V, Villella, M, Pileri, M, Guglielmi, G, Di Giorgio, A, Modoni, S, Fusilli, S, Di Cerbo, A, Liuzzi, A 1997Skeletal involvement in female acromegalic subjects: the effects of growth hormone excess in amenorrheal and menstruating patientsJ Bone Miner Res1217291736PubMedGoogle Scholar
  5. 5.
    Chiodini, I, Trischitta, V, Carnevale, V, Liuzzi, A, Scillitani, A 2001Bone mineral density in acromegaly: does growth hormone excess protect against osteoporosis?J Endocrinol Invest24288291PubMedGoogle Scholar
  6. 6.
    Lesse, GP, Fraser, WD, Farquharson, R, Hipkin, L, Vora, JP 1998Gonadal status is an important determinant of bone density in acromegalyClin Endocrinol (Oxf)485965CrossRefGoogle Scholar
  7. 7.
    Ezzat, S, Melmed, S, Endres, D, Eyre, DR, Singer, FR 1993Biochemical assessment of bone formation and resorption in acromegalyJ Clin Endocrinol Metab7614521457PubMedCrossRefGoogle Scholar
  8. 8.
    Bolanowski, M, Jędrzejuk, D, Milewicz, A, Arkowska, A 2002Quantitative ultrasound of the heel and some parameters of bone turnover in patients with acromegalyOsteoporos Int13303308PubMedCrossRefGoogle Scholar
  9. 9.
    Colao, A, Cannavo, S, Marzullo, P, Pivonello, R, Squadrito, S, Vallone, G, Almoto, B, Bichisao, E, Trimarchi, F, Lombardi, G 2003Twelve months of treatment with octreotide-LAR reduces joint thickness in acromegalyEur J Endocrinol1483138PubMedGoogle Scholar
  10. 10.
    Ohlsson, C, Bengtsson, B-A, Isaksson, O, Andreassen, TT, Slootweg, MC 1998Growth hormone and boneEndocr Rev195579PubMedCrossRefGoogle Scholar
  11. 11.
    Bolanowski, M, Wielgus, W, Milewicz, A, Marciniak, R 2000Axial bone mineral density in patients with acromegalyAcad Radiol7592594PubMedCrossRefGoogle Scholar
  12. 12.
    Scillitani, A, Battista, C, Chiodini, I, Carnevale, V, Fusilli, S, Ciccarelli, E, Terzolo, M, Oppizzi, G, Arosio, M, Gasperi, M, Arnaldi, G, Colao, A, Baldelli, R, Ghiggi, MR, Gaia, D, Di Somma, C, Trischitta, V, Liuzzi, A 2003Bone mineral density in acromegaly: the effect of sex, disease activity and gonadal statusClin Endocrinol (Oxf)58725731CrossRefGoogle Scholar
  13. 13.
    Kanis, JA 1997OsteoporosisBlackwell Healthcare CommunicationsLondon114147Google Scholar
  14. 14.
    Kayath, MJ, Vieira, JGH 1997Osteopenia occurs in a minority of patients with acromegaly and is predominant in the spineOsteoporos Int7226230PubMedCrossRefGoogle Scholar
  15. 15.
    Longobardi, S, Di Somma, C, Di Rella, F, Angelillo, N, Ferone, D, Colao, A, Merola, B, Lombardi, G 1998Bone mineral density and circulating cytokines in patients with acromegalyJ Endocrinol Invest21688693PubMedGoogle Scholar
  16. 16.
    Kaji, H, Sugimoto, T, Nakaoka, D, Okimura, Y, Kaji, H, Abe, H, Chihara, K 2001Bone metabolism and body composition in Japanese patients with active acromegalyClin Endocrinol (Oxf)55175181CrossRefGoogle Scholar
  17. 17.
    Kotzmann, H, Bernecker, P, Hubsch, P, Pietschmann, P, Woloszczuk, W, Svoboda, T, Geyer, G, Luger, A 1993Bone mineral density and parameters of bone metabolism in patients with acromegalyJ Bone Miner Res8459465PubMedCrossRefGoogle Scholar
  18. 18.
    Colao, A, De Rosa, M, Pivonello, R, Balestrieri, A, Cappabianca, P, Di Sarno, A, Rochira, V, Carani, C, Lombardi, G 2002Short-term suppression of GH and IGF-1 levels improves gonadal function and sperm parameters in men with acromegalyJ Clin Endocrinol Metab8741934197PubMedGoogle Scholar
  19. 19.
    Morimoto, I, Kai, K, Okada, Y, Okimoto, N, Uriu, K, Akino, K, Yamashita, S, Nakamura, T, Eto, S 2000Skeletal changes in rats bearing mammosomatotrophic pituitary tumors: a model of acromegaly with gonadal dysfunctionBone26255261PubMedCrossRefGoogle Scholar
  20. 20.
    Marazuela, M, Astigarraga, B, Tabuenca, MJ, Estrada, J, Marin, F, Lucas, T 1993Serum bone gla protein as a marker of bone turnover in acromegalyCalcif Tissue Int52419421PubMedCrossRefGoogle Scholar
  21. 21.
    Piovesan, A, Terzolo, M, Reimondo, G, Pia, A, Codegone, A, Osella, G, Boccuzzi, A, Paccotti, P, Angeli, A 1994Biochemical markers of bone and collagen turnover in acromegaly or Cushing's syndromeHorm Metab Res26234237PubMedCrossRefGoogle Scholar
  22. 22.
    Legovini, P, De Menis, E, Breda, F, Billeci, D, Carteri, A, Pavan, P, Conte, N 1997Long-term effects of octreotide on markers of bone metabolism in acromegaly: evidence of increased serum parathormone concentrationsJ Endocrinol Invest20434438PubMedGoogle Scholar
  23. 23.
    Cantatore, FP, Loverro, G, Ingrosso, AM, Lacanna, R, Sassanelli, E, Salvaggi, L, Carrozzo, M 1995Effect of oestrogen replacement on bone metabolism and cytokines in surgical menopauseClin Rheumatol14157160PubMedGoogle Scholar
  24. 24.
    Orwoll, ES, Klein, RF 1995Osteoporosis in menEndocr Rev1687116PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Marek Bolanowski
    • 1
  • Jacek Daroszewski
    • 1
  • Marek Mędraś
    • 1
  • Beata Zadrożna-Śliwka
    • 1
  1. 1.Department of Endocrinology and DiabetologyWrocław Medical UniversityWrocławPoland

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