Faculty Collaboration Database

Calcium and Bone Turnover Markers in Acromegaly: A Prospective, Controlled Study. J Clin Endocrinol Metab 2017 Jul 01;102(7):2416-2424

Date

04/14/2017

Pubmed ID

28407138

DOI

10.1210/jc.2016-3693

Scopus ID

2-s2.0-85023181697 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

CONTEXT: Acromegaly has been associated with calcium-phosphate and bone turnover alterations. Controlled studies of these interactions are sparse.

OBJECTIVE: To evaluate calcium and bone metabolism in active and treated acromegaly.

DESIGN/SETTING/PATIENTS: We conducted a controlled, prospective study at a tertiary referral center. We studied 22 patients with acromegaly referred for surgical or medical therapy (ACM) and 22 with nonfunctioning pituitary adenomas referred for surgery (control).

MAIN OUTCOME MEASURES: Calcium (serum and urine), phosphorus, parathyroid hormone (PTH), 25-hydroxy- and 1,25-dihydroxy-vitamin D, bone turnover markers [serum C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)], and cytokines [receptor activator of nuclear factor κB ligand (RANK-L) and osteoprotegerin (OPG)] at baseline and 3 to 6 months after treatment.

RESULTS: At baseline, the ACM group had lower PTH levels than controls (36.3 ± 13.9 pg/mL vs 56.0 ± 19.9 pg/mL) and higher phosphorus (4.34 ± 0.71 mg/dL vs 3.55 ± 0.50 mg/dL) (P < 0.01). Groups had similar levels of serum and urine calcium and 25-hydroxy- and 1,25-dihydroxy-vitamin D. The ACM group had higher bone turnover markers than control; P1NP and CTX were strongly correlated (r2 = 0.82, P < 0.05). CTX was dependent on age and disease group but not on sex or gonadal status. After treatment of acromegaly, serum calcium (9.52 ± 0.43 mg/dL to 9.26 ± 0.28 mg/dL), phosphorus (4.34 ± 0.71 mg/dL to 3.90 ± 0.80 mg/dL), and CTX (0.91 ± 0.75 ng/mL to 0.63 ± 0.68 ng/mL) decreased, while PTH increased (36.3 ± 13.9 pg/mL to 48.9 ± 16.7 pg/mL) (P < 0.01). 25-hydroxy-vitamin D, P1NP, and RANK-L/OPG ratio did not change significantly.

CONCLUSION: Acromegaly patients exhibited PTH-independent calcium-phosphate alterations and enhanced coupled bone formation and resorption. Within 6 months of treatment, bone resorption decreased, whereas RANK-L/OPG changes were inconsistent.

Author List

Constantin T, Tangpricha V, Shah R, Oyesiku NM, Ioachimescu OC, Ritchie J, Ioachimescu AG

Authors

Octavian C. Ioachimescu MD, PhD Vice Chair, Director, Professor in the Medicine department at Medical College of Wisconsin
Adriana G. Ioachimescu MD, PhD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acromegaly
Adult
Analysis of Variance
Bone Remodeling
Bone Resorption
Bone and Bones
Calcium Phosphates
Case-Control Studies
Female
Humans
Male
Middle Aged
Parathyroid Hormone
Prognosis
Prospective Studies
Regression Analysis
Severity of Illness Index
Somatostatin
Statistics, Nonparametric
Young Adult