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.