Journal of Korean Endocrine Society 1999;14(4):688-697.
Published online January 1, 2001.
Bone Turnover and Bone Mineral Density in Acromegaly.
Sun Wook Kim, Hee Jin Kim, Seon Hwa Lee, Won Bae Kim, Do Joon Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
Department of Internal Medicine, College of Medicine, Institute of Endocrinology, Nutrition and Metabolism, Medical Research Center, Center for Hormone Research, Clinical Research Institute, Seoul National University, Seoul, Korea/
Abstract
BACKGROUND
Abnormalities of calcium homeostasis and bone remodelling were known in acromegaly, but controversy concerning the influence of chronically elevated serum growth hormone (GH)/insulin like growth factor-I (IGF-I) concentrations on bone metabolism has been existed. In this study, we assess the effect of chronically elevated serum GH/IGF-I levels on bone metabolism and bone mineral density (BMD) in patients with acromegaly and compare the markers of bone metabolism and BMD of active acromegaly according to gonadal function. METHODS: We measured biochemical markers of bone turnover and BMD in 50 acromegalic patients (41 active disease, 9 inactive disease) and 41 control subjects. RESULTS: Active acromegalic patients had significantly higher serum oteocalcin levels (13.8+/-7.7 versus 6.8+/-4.7, 6.0+/--3.4 ng/mL, p<0.05) and urinary type I cross-linked N-telopeptide (101.7+/-64.2 versus 49.3+/-33.3, 56.1+/-39.4 nM BCM/mM Cr, p<0.05) compared with inactive acromegaly and control subjects. Serum IGF-I levels correlated positively with serum osteocalcin levels(r=0.69, p<0.05) and urinary type I cross-linked N-telopeptide (r=0.44, p<0.05). In the female patients with active acromegaly, BMD (T-score) was elevated in the femoral neck(1.00+/-0.14 versus 0.89+/-0.12,p<0.05) and trochanter (0.88+/-0.15 versus 0.77+/-0.11, p<0.05), whereas BMD of lumbar spine(1.13+/- 0.17 versus 1.17+/-0.17, p>0.05) and femoral Ward's triangle (0.78+/-0.16 versus 0.77+0.13, p>0.05) were not different from those of control subjects. In the patients with active acromegaly, serum osteocalcin levels (16.4+/-8.8 versus 14.9+/-10.1 ng/mL, p>0.05) as well as urinary type I cross-linked N-telopeptide (104.8+/-68.1 versus 122.0+/-80.3 nM BCM/mM Cr, p>0.05) were not different according to gonadal function. Also, femoral and spinal BMD were not different according to the gonadal function. CONCLUSION: GH/IGF-I excess increase bone turnover and might achieve a positive bone balance at each remodelling cycle. Markers of bone turnover and BMD of skeletal bone were not influenced by gonadal function in the patients with active acromegaly.
Key Words: Acromegaly, Biochemical bone turnover markers, Bone mineral density


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