Bone and Joint Quality Remains Impaired in Long-Term Controlled Acromegaly: An HR-pQCT Study
Christian Rosendal, Frederik Oestergaard Klit, Annika Vestergaard Kvist, Peter Vestergaard, Jakob DalAbstract
Context
Joint and bone disorders are frequent, disabling complications of acromegaly that progress despite biochemical remission. HR-pQCT provides precise assessment of bone and joint quality.
Objective
To evaluate joint and bone quality in patients with long-term controlled acromegaly.
Design
Cross-sectional study.
Participants
17 acromegaly patients and 17 age- and sex-matched controls.
Measures
HR-pQCT of hand joints, tibia and radius; bone microindentation; vertebral fracture assessment; dual X-ray absorptiometry; circulating bone biomarkers; questionnaires.
Results
Patients with acromegaly (mean age: 61.8 years, mean disease duration: 13.1 years, mean IGF-I xULN: 0.9) had wider joint spaces of the second (2.85 vs. 2.68 mm, p = 0.004) and third (2.92 vs. 2.80 mm, p = 0.037) metacarpophalangeal joints, the latter with a higher risk of osteophytes (50% vs. 11.8%, p = 0.017). Vertebral deformities were more common (88% vs. 47%, p = 0.01), more numerous (2.1 vs. 0.7, p < 0.001), and associated with higher spinal deformity indices (2.6 vs. 1.3, p = 0.04) in participants with acromegaly. HR-pQCT demonstrated lower trabecular bone mineral density in the radius (114.8 vs. 150.3 mg/cm3, p = 0.008) and tibia (129.3 vs. 166.2 mg/cm3, p = 0.002), as well as fewer (1.63 vs. 2.11 mm-1, p = 0.001) and thinner (0.056 vs. 0.064 mm, p = 0.005) trabeculae. Bone and joint abnormalities increased with age, and spinal deformity index correlated positively with arthropathy indices, only in the acromegaly group.
Conclusions
Long-term, biochemically controlled acromegaly is associated with structural joint alterations and impaired bone microarchitecture, even years after diagnosis.