Romy van der Groef¹, Julie Refardt¹, Els van Zaanen¹, Evert van Velsen¹, Sebastian Neggers¹

(1) Internal Medicine, Erasmus MC, Internal Medicine Section Endocrinology, Rotterdam, Netherlands, Rotterdam, Zuid-Holland.

Introduction

Patients with acromegaly and Cushing’s disease are thought to have an increased risk for vertebral fractures often independent of osteoporosis. This study aimed to assess the correlation between bone mineral density (BMD) and bone quality, measured by Trabecular Bone Score (TBS), with fracture prevalence in these patients.

Methods

A retrospective, cross-sectional analysis was conducted on BMD at the femoral neck and lumbar spine (L1-L4), TBS, and fracture prevalence in patients with acromegaly and Cushing’s disease. Vertebral fractures with a Genant score >= 2 were considered clinically significant.

Results

A total of 105 patients (40 with Cushing’s disease, 65 with acromegaly) 61.9% female, aged 59 years (SD 14.1) were included, . Mean femoral neck and lumbar spine BMD T-scores were -1.09 (0.82) and -0.42 (1.44) for Cushing’s disease, and -0.31 (1.69) and 0.41 (2.06) for acromegaly. Corresponding mean TBS T-scores were -3.3 (rho =0.10) and -2.29 (rho=0.47), respectively. Vertebral fractures were observed in 10 patients (9.5%), with 70% of these having a TBS score < -2.5, while only 30% had osteoporosis.No differences were found between patients with active versus controlled disease, or between those with adequate versus untreated hypogonadism.

Conclusion

In this large series of patients with Cushing’s disease and acromegaly, the observed prevalence of vertebral fractures was lower than previously reported, with only a small proportion of patients diagnosed with osteoporosis. the discrepancy between BMD and TBS suggests that TBS can provide valuable insights for assessing bone health and fracture risk in these patients.