Bone and joint quality remains impaired in long-term controlled acromegaly: an HR-pQCT study.

Abstract

Context: Joint and bone disorders are frequent, disabling complications of acromegaly that progress despite biochemical remission. HR-pQCT provides a 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 = .004) and third (2.92 vs 2.80 mm, P = .037) metacarpophalangeal joints, the latter with a higher risk of osteophytes (50% vs 11.8%, P = .017). Vertebral deformities were more common (88% vs 47%, P = .01), more numerous (2.1 vs 0.7, P < .001), and associated with higher spinal deformity indices (2.6 vs 1.3, P = .04) in participants with acromegaly. HR-pQCT demonstrated lower trabecular bone mineral density in the radius (114.8 vs 150.3 mg/cm³, P = .008) and tibia (129.3 vs 166.2 mg/cm³, P = .002), as well as fewer (1.63 vs 2.11 mm^-1, P = .001) and thinner (0.056 vs 0.064 mm, P = .005) trabeculae. Bone and joint abnormalities increased with age, and the spinal deformity index correlated positively with arthropathy indices, only in the acromegaly group.

Conclusion: Long-term, biochemically controlled acromegaly is associated with structural joint alterations and impaired bone microarchitecture, even years after diagnosis.