Osteoporosis in pituitary diseases: lessons for the clinic

Abstract

Osteoporosis is a systemic disease characterized by bone mass and density loss leading to fragility fractures. Osteoporosis due to endocrine disorders is an example of secondary osteoporosis. The harmful effects on bones are common in patients harboring pituitary tumors (acromegaly, prolactinoma, Cushing’s disease) and suffering from hypopituitarism. Increased fracture risk and high healthcare costs of fractured patients are their consequences. The coexistence of some of these disorders and hypogonadism results in severe osteoporosis. The influence of the certain diseases, their activity and therapy and accompanying hypogonadism on bone turnover, bone mineral density and fracture incidence is presented.

Keywords:

• acromegaly
• bone density
• bone turnover
• Cushing’s syndrome
• fractures
• hypopituitarism
• prolactinoma
• secondary osteoporosis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Osteoporosis due to hormonal disorders is an example of secondary osteoporosis.

• Pituitary adenoma can affect bone metabolism through the hypersecretion of certain pituitary hormones or secondary hypopituitarism.

• There is high prevalence of moderate and severe vertebral fractures in acromegalic patients, independently of bone mineral density and disease control, but often related to hypogonadism.

• Hyperprolactinemia can directly stimulate bone turnover, with more influence on bone resorption than formation.

• Hyperprolactinemia is associated with increased fracture risk.

• In Cushing’s syndrome, facture risk is related to age at onset, disease duration and severity of the disease, even in cured patients.

• Fracture risk assessment using modern and available tools (e.g., FRAX) should be widely implemented in patients harboring pituitary tumors.