Impact of the diagnostic delay of acromegaly on bone health: data from a real life and long term follow-up experience

M. Veleno*^a (Dr), S. Chiloiro^a (Dr), A. Giampietro^a (Dr), I. Gagliardi^b (Dr), M. Bondanelli^b (Prof), MR. Ambrosio^b (Prof), MC. Zatelli^b (Prof), A. Pontecorvi^a (Prof), A. Giustina^c (Prof), L. De Marinis^a (Prof), A. Bianchi^d (Dr)

^a Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy, Roma, ITALY ; ^b Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy, Ferrara, ITALY ; ^c Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milano, Italy, Milano, ITALY ; ^d Endocrinology and Diabetology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy, Rome, ITALY

* miriam.veleno@gmail.com

Introduction: Acromegaly is a chronic disease with systemic complications. Disease onset is insidious and consequently typically burdened by diagnostic delay. A longer diagnostic delay induces more frequently cardiovascular, respiratory, metabolic and musculoskeletal comorbidities. No data are available on the effect of diagnostic delay on skeletal fragility. We aimed to evaluate the effect of diagnostic delay on the frequency of incident and prevalent of vertebral fractures (i-VFs and p-VFs) in a large cohort of acromegaly patients.

Patients and methods: A longitudinal, retrospective and multicenter study was conducted on 172 acromegaly patients.

Results: Median diagnostic delay and duration of follow-up were respectively 10 years (IQR: 6) and 10 years (IQR: 8). P-VFs were observed in 18.6% and i-VFs occurred in 34.3% of patients. The median estimated diagnostic delay was longer in patients with i-VFs (median: 11 years, IQR: 3), in comparison to those without i-VFs (median: 8 years, IQR: 7; p=0.02). Age at acromegaly diagnosis and at last follow-up were higher in patients with i-VFs, with respect to those without i-VFs. The age at acromegaly diagnosis positively correlated with the diagnostic delay (p<0.001, r=0.216). A longer history of active acromegaly was associated with a high frequency of i-VFs (p=0.03). The logistic regression confirmed that patients with a diagnostic delay > 10 years had 1.5-folds increased risk of developing i-VFs (OR: 1.5; 95%CI: 1.1-2; p=0.017).

Conclusion: Our data showed that the diagnostic delay in acromegaly has a significant impact on VF risk, further supporting the clinical relevance of an early acromegaly diagnosis.

The author has declared no conflict of interest.