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High prevalence of vertebral deformity in tumor-induced osteomalacia associated with impaired bone microstructure

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Abstract

Purpose

Patients with tumor-induced osteomalacia (TIO) often suffer from irreversible height loss due to vertebral deformity. However, the prevalence of vertebral deformity in TIO patients varies among limited studies. In addition, the distribution and type of vertebral deformity, as well as its risk factors, remain unknown. This study aimed to identify the prevalence, distribution, type and risk factors for vertebral deformity in a large cohort of TIO patients.

Methods

A total of 164 TIO patients were enrolled in this retrospective study. Deformity in vertebrae T4–L4 by lateral thoracolumbar spine radiographs was evaluated according to the semiquantitative method of Genant. Bone microstructure was evaluated by trabecular bone score (TBS) and high-resolution peripheral QCT (HR-pQCT).

Results

Ninety-nine (99/164, 60.4%) patients had 517 deformed vertebrae with a bimodal pattern of distribution (T7–9 and T11–L1), and biconcave deformity was the most common type (267/517, 51.6%). Compared with patients without vertebral deformity, those with vertebral deformity had a higher male/female ratio, longer disease duration, more height loss, lower serum phosphate, higher bone turnover markers, lower TBS, lower areal bone mineral density (aBMD), lower peripheral volumetric BMD (vBMD) and worse microstructure. Lower trabecular vBMD and worse trabecular microstructure in the peripheral bone and lower spine TBS were associated with an increased risk of vertebral deformity independently of aBMD. After adjusting for the number of deformed vertebrae, we found little difference in clinical indexes among the patients with different types of vertebral deformity. However, we found significant correlations of clinical indexes with the number of deformed vertebrae and the spinal deformity index.

Conclusion

We reported a high prevalence of vertebral deformity in the largest cohort of TIO patients and described the vertebral deformity in detail for the first time. Risk factors for vertebral deformity included male sex, long disease duration, height loss, abnormal biochemical indexes and bone impairment. Clinical manifestation, biochemical indexes and bone impairment were correlated with the number of deformed vertebrae and degree of deformity, but not the type of deformity.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

We appreciate our patients for their participation in this study.

Funding

This study was supported by the National Natural Science Foundation of China (No.81970757 and No. 81900798).

Author information

Author notes

  1. X. Ni and W. Guan contributed equally to this paper.

Authors and Affiliations

  1. Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China

    X. Ni, Y. Jiang, X. Li, Y. Chi, Q. Pang, W. Liu, R. Jiajue, O. Wang, M. Li, X. Xing & W. Xia

  2. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China

    W. Guan & W. Yu

  3. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    W. Guan

  4. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    H. Wu

  5. Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    L. Huo

  6. Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Y. Liu, J. Jin & X. Zhou

  7. Department of Ear, Nose, and Throat, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    W. Lv

  8. Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    L. Zhou

  9. Department of Ultrasound Diagnosis, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Y. Xia

  10. Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Y. Gong

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  1. X. Ni
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  2. W. Guan
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  3. Y. Jiang
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  21. W. Yu
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Corresponding authors

Correspondence to W. Yu or W. Xia.

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This study was approved by the Local Ethics Committee of the Department of Scientific Research at PUMCH.

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Ni, X., Guan, W., Jiang, Y. et al. High prevalence of vertebral deformity in tumor-induced osteomalacia associated with impaired bone microstructure. J Endocrinol Invest 46, 487–500 (2023). https://doi.org/10.1007/s40618-022-01918-z

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