VERTEBRAL FRACTURES ASSOCIATED WITH SPINAL SAGITTAL IMBALANCE AND QUALITY OF LIFE IN ACROMEGALY: A RADIOGRAPHIC STUDY WITH EOS 2D/3D TECHNOLOGY

Introduction: Acromegaly is commonly complicated by arthropathy and skeletal fragility with high risk of vertebral fractures (VFs). Objective: This study aimed to assess whether VFs may be associated with sagittal spine deformities, arthropathy, impaired quality of life (QoL), pain and disability. Methods: Thirty-eight patients with acromegaly (median age 55 years, 20 males) and 38 matched-control subjects were evaluated by a low dose sagittal and coronal planes, X-ray imaging system (EOS®-2D/3D) for morphometric VFs, radiological signs of spine arthropathy and spine deformities (Cobb thoracic index ≥ 40°, pelvic incidence minus lumbar lordosis ≥ 10°, pelvic tilt > 20°, sagittal vertical axis ≥ 4 cm) determining sagittal spine imbalance. Acromegalic patients were also evaluated by questionnaires for QoL (Acromegaly QoL Questionnaire [AcroQoL] and Short Form-36 [SF36]), pain and disability (Western Ontario and Mc Master University [WOMAC]. Results: Acromegalic patients showed higher prevalence of thoracic hyperkyphosis (i.e., Cobb thoracic index ≥ 40°; p=0.04), pelvic tilt > 20° (p=0.02) than control subjects. VFs were found in 34.2% of acromegalic patients (p=0.003 vs. control subjects), in relationship with higher prevalence of hyperkyphosis (p=0.03), pelvic tilt > 20° (p=0.04), sagittal vertical axis ≥ 4 cm (p=0.03) and moderate/severe subchondral degeneration (p=0.01). Moreover, patients with VFs had lower AcroQoL general health (p=0.007) and SF36 general health (p=0.002) scores and higher WOMAC pain (p=0.003) and global (p=0.009) scores than patients who did not fracture. Conclusions: In acromegaly, VFs may be associated with spine deformities and sagittal imbalance, spine arthropathy, impaired QoL and disability.