Epicardial fat is a negative predictor of spine volumetric bone mineral density and trabecular bone score in acromegaly
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RESEARCH LETTER
Epicardial fat is a negative predictor of spine volumetric bone mineral density and trabecular bone score in acromegaly Elena Valassi1 • Iris Crespo1 • Jorge Malouf2 • David Vilades3 • Ruben Leta3 Jaume Llauger4 • Eula`lia Urgell5 • Anna Aulinas1 • Ana Maria Marı´n2 • Betina Biagetti6 • Susan M. Webb1
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Received: 14 January 2016 / Accepted: 26 March 2016 Ó Springer Science+Business Media New York 2016
Keywords Acromegaly Epicardial fat Volumetric bone mineral density Trabecular bone score Dickkopfrelated protein 1 (DKK1) Abbreviations ACRO Acromegaly aBMD Areal bone mineral density CTx C-terminal telopeptide of type 1 collagen aBMD Areal bone mineral density DKK1 Dickkopf-related protein 1 DXA Dual-energy X-ray absorptiometry EAT Epicardial adipose tissue FFA Free fatty acids GH Growth hormone GHD Growth hormone deficiency
IGF-I LS vBMD MDCT rGH QCT SAT TBS P1NP VAT Wnt
Insulin-like growth factor-I Lumbar spine volumetric bone mineral density Multidetector computed tomography Recombinant growth hormone Quantitative computed tomography Subcutaneous adipose tissue Trabecular bone score Total procollagen type 1 amino-terminal propeptide Visceral adipose tissue Wingless-type
Introduction
& Elena Valassi [email protected] 1
Endocrinology/Medicine Department, Research Center for Pituitary Diseases, Hospital Sant Pau, Centro de Investigacio´n Biome´dica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Auto`noma de Barcelona (UAB), c/Sant Antoni Ma Claret 167, 08025 Barcelona, Spain
2
Mineral Metabolism Unit, Medicine Department, Hospital Sant Pau, Barcelona, Spain
3
Cardiology Department, Hospital Sant Pau, Barcelona, Spain
4
Radiology Department, Hospital Sant Pau, Barcelona, Spain
5
Biochemistry Department, Hospital Sant Pau, Barcelona, Spain
6
Endocrinology Department, Hospital Vall d’Hebron, Barcelona, Spain
Growth hormone (GH) and insulin-like growth factor-I (IGF-I) excess in acromegaly (ACRO) are associated with abnormal bone remodeling and fat distribution [1]. GH and IGF-I play an important role in regulating body composition and modulating the interaction linking bone and fat. While GH is lipolytic and stimulates lipid oxidation [2], GH and IGF-I play an anabolic effect on bone, enhancing osteoblast differentiation and bone formation [3]. Thus, ACRO may be an interesting model to gain insight into the relationship between bone and fat, and its potential hormone determinants. Patients with ACRO are at elevated risk of vertebral fractures [4], even in the presence of normal areal bone mineral density (aBMD), suggesting that exposure to GH/ IGF-I excess may be associated with impaired bone microarchitecture [5]. ACRO is also characterized by a change in fat distribution, namely reductions of both
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Endocrine
subcutaneous (SAT) and visceral abdominal adipose tissue (VAT) [2]. Epicardial adipose tissue (EAT) is a visceral fat depot located between the outer wall of the myocardium and the visceral layer of the pericardium, and
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