Musculoskeletal disease in acromegaly – a population-based registry study

Abstract Objective Acromegaly is associated with multiple musculoskeletal complications that affect quality of life and work ability. We aimed to examine the risk of osteoarthritis, musculoskeletal surgery (incl. joint replacement), osteoporosis, fractures and analgesic consumption in Danish acromegaly patients. Design National, registry-based cohort study. Methods All validated incident and prevalent cases of acromegaly in the period 1977-2021 (n=844) were included and matched 1:100 with healthy controls. Outcomes were identified using diagnosis, surgical procedure and medication codes, and analyzed using Cox regression and Kaplan-Meier plots. Results Patients were at significantly increased risk of osteoarthritis of the shoulder (HR: 5.25 [3.05; 9.06]), hip (HR: 3.15 [2.57; 3.87]) and knee (HR: 2.25 [1.85; 2.72]), and medically treated osteoporosis (HR: 2.13 [1.64; 2.78]) even before acromegaly diagnosis. The risk of joint replacement surgery of the shoulder (HR: 4.60 [2.57; 8.25]), hip (HR: 3.32 [2.67; 4.12]) and knee (HR: 2.52 [1.89; 3.36]) was increased in acromegaly patients, as was the risk of being prescribed weak analgesics (HR: 1.22 [1.04; 1.44]) or opioids (HR: 1.58 [1.38; 1.82]). Surgical complications (HR: 2.19 [1.59; 3.03]) and repeat hip surgery (HR: 3.64 [2.09; 6.34]) also exhibited increased risk in patients. Conclusion In acromegaly, severe osteoarthritis involving multiple joints develops even before acromegaly diagnosis and continues to progress over time after acromegaly treatment. Furthermore, acromegaly imposes an increased risk of medically treated osteoporosis, musculoskeletal surgery - particularly joint replacement surgery -, surgical complications and necessity of analgesic medication. Our findings warrant further research into the management of musculoskeletal disease in acromegaly.