Treatment of Acromegalic Osteopathy in Real-Life Clinical Practice: The BAAC (Bone Active drugs in ACromegaly) Study

Background: Vertebral fractures (VFs) are a frequent complication of acromegaly, but no studies have been so far published on effectiveness of anti-osteoporotic drugs in this clinical setting. Objective: To evaluate whether in real-life clinical practice bone-active drugs may reduce the risk of VFs in patients with active or controlled acromegaly. Study design: Retrospective-longitudinal study including 9 tertiary care Endocrine Units. Patients and methods: Two-hundred-forty-eight patients with acromegaly (104 males; mean age 56.0±13.6 years) were evaluated for prevalent and incident VFs by quantitative morphometric approach. Bone-active agents were used in 52 patients (20.97%) and the median period of follow-up was 48 months (range 12-132). Results: During the follow-up, 65 patients (26.21%) developed incident VFs in relationship with pre-existing VFs (odds ratio (OR) 3.75; p<0.001), duration of active acromegaly (OR 1.01; p=0.04), active acromegaly at the study entry (OR 2.48; p=0.007) and treated hypoadrenalism (OR 2.50; p=0.005). In the entire population, treatment with bone active drugs did not have a significant effect on incident VFs (p=0.82). However, in a sensitive analysis restricted to patients with active acromegaly at the study entry (111 cases), treatment with bone-active drugs was associated with a lower risk of incident VFs (OR 0.11; p=0.004), independently of prevalent VFs (OR 7.65; p<0.001) and treated hypoadrenalism (OR 3.86; p=0.007). Conclusions: Bone-active drugs may prevent VFs in patients with active acromegaly.