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Cited by 27Bone health and osteoporosis researchPituitary Gland Disorders and TreatmentsBone Metabolism and Diseases

Pituitary Disorders and Osteoporosis

Open access
Bolanowski, Marek, Halupczok, Jowita, Jawiarczyk-Przybyłowska, Aleksandra·2015·International Journal of Endocrinology
DOI 10.1155/2015/206853PMC PMC4383139
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Abstract

Various hormonal disorders can influence bone metabolism and cause secondary osteoporosis. The consequence of this is a significant increase of fracture risk. Among pituitary disorders such effects are observed in patients with Cushing’s disease, hyperprolactinemia, acromegaly, and hypopituitarism. Severe osteoporosis is the result of the coexistence of some of these disorders and hypogonadism at the same time, which is quite often.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review examines how pituitary disorders — Cushing's disease, hyperprolactinemia, acromegaly, and hypopituitarism/GH deficiency — cause secondary osteoporosis and increase fracture risk, often through mechanisms beyond bone mineral density (BMD). It emphasizes that fractures frequently occur despite normal or only slightly reduced BMD, so bone quality assessment and early treatment of the underlying disease are central to management.

Key findings

  • In Cushing's syndrome, glucocorticoid excess inhibits bone formation and enhances resorption; among 58 pituitary-dependent and 21 adrenal-dependent patients, 82% had osteopenia by WHO criteria, with lower lumbar spine than femoral neck BMD (difference not statistically significant). Vertebral fractures occur in up to 70% of patients with endogenous hypercortisolism, and osteoporosis/atraumatic fractures are more prevalent in adrenal than pituitary Cushing's syndrome.
  • In hyperprolactinemia, a study of males found low lumbar spine BMD in 80% of patients versus reduced femoral neck BMD in only 30%; bone loss risk factors were disease duration and hypogonadism. Dopamine agonist therapy (bromocriptine, quinagolide, or cabergoline) over 18 months normalized PRL, osteocalcin, and gonadal function but did not fully restore lumbar spine or femoral neck BMD or normalize Ntx.
  • In acromegaly, reported vertebral fracture prevalence varies between 39% and 59%; fractures are more frequent and more severe/multiple in men, and Claessen et al. found vertebral fractures progressed long-term in 20% of patients with biochemically controlled disease despite absence of osteoporosis or osteopenia. Bone turnover is increased, with elevated osteocalcin and resorption markers.
  • In hypopituitarism/GHD, a meta-analysis found recombinant human GH significantly increased BMD in randomized/controlled studies longer than 12 months (doses 0.2–0.96 mg/day, higher in women and childhood-onset GHD); Holmer et al. found women with childhood-onset GHD had more than doubled risk for nonosteoporotic fractures, while adult-onset GHD men had significantly decreased fracture incidence.

Methods

  • Narrative review of the literature on pituitary disorders and osteoporosis, covering Cushing's disease, hyperprolactinemia, acromegaly, and hypopituitarism/GH deficiency.
  • Summarizes mechanisms of hormone effects on bone (Table 1) and their influence on bone turnover, bone density, and fracture risk (Table 2), drawing on cited studies including DXA, trabecular bone score (TBS), quantitative ultrasound, and HR-pQCT.
  • No primary data collection or systematic search methodology is described.

Limitations

  • Not stated in the paper: the review does not include a limitations section or describe its search strategy, inclusion criteria, or risk of bias.
  • Evident from the text: the authors repeatedly note conflicting BMD findings in acromegaly, attributing variation to gonadal status, skeletal site, technique, gender, age, and disease activity, which limits firm conclusions.
  • Evident from the text: several cited studies are small (e.g., 58 pituitary-dependent and 21 adrenal-dependent Cushing's patients), and the review relies on heterogeneous observational designs.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1155/2015/206853

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

15 of 219 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Some pituitary diseases can influence bone mineral density and bone turnover, causing osteopenia, osteoporosis, and fractures.

    “Some pituitary diseases may influence bone mineral density (BMD) and bone turnover causing osteopenia, osteoporosis, and fractures [2].”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Premisecitation

    The trabecular bone score has been introduced as a method of bone quality estimation in glucocorticoid-induced osteoporosis.

    “The trabecular bone score (TBS) has been recently introduced as a method of bone quality estimation in GIO [10, 15].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [10] 2013, Clinical Endocrinology source
    • cites [15] source
  • Premisecitation

    The prevalence of osteoporosis and atraumatic fractures is higher in adrenal Cushing's syndrome than in pituitary Cushing's syndrome.

    “The prevalence of osteoporosis and atraumatic fractures is higher in adrenal Cushing's syndrome than in pituitary Cushing's syndrome [11].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • Interpretationcitation

    Conflicting data on bone mineral density in acromegaly might be related to gonadal status, different skeletal sites measured, various techniques employed, subject's gender, age, and activity of the disease.

    “Conflicting data on bone mineral density might be related to gonadal status, different skeletal sites being measured, various techniques employed, subject's gender, age, and activity of the disease [28, 36, 38].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [28] source
    • cites [36] source

      The Abstract and Discussion attribute conflicting BMD findings to differences in gonadal status, disease activity, gender-related stratification, and skeletal site. The Measurements section accounts for patients’ ages and different devices, but the paper does not identify age or measurement techniques as reasons previous studies conflicted. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [38] source
  • Premisecitation

    In patients with acromegaly, changes in bone size and density and arthropathy are common problems.

    “In patients with acromegaly changes in bone size and density and arthropathy are common problems [31–33].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [31] source

      The Acromegalic Arthropathy section (page not available in our copy) calls arthropathy one of the most frequent complications of acromegaly and reports joint involvement in many patients. It describes cartilage growth and osteophyte formation, but does not establish that changes in bone size and density are common problems. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [32] source
    • cites [33] source
  • May combine two claims. 48
  • Classified as probably not a substantial claim. 2
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Information about the influence of GH excess on BMD varies in the literature: in some studies BMD was increased or within reference ranges, while in other papers it was decreased.

    “Information about the influence of GH excess on BMD varies in the literature. In some studies BMD was reported to be increased or within the reference ranges, while in other papers it was decreased [17, 26, 34–37].”
    Quote in the paperNot a substantial claim1 of 6 sources checked
    • cites [17] source
    • cites [26] source
    • cites [34] source
    • cites [35] 1993, Journal of Bone and Mineral Research source
    • cites [36] source
    • cites [37] source

  • May combine two claims.

    Premisecitation

    Patients with isolated GH deficiency and with multiple pituitary deficiencies usually have low BMD.

    “Patients with isolated GH deficiency (GHD) and with multiple pituitary deficiencies usually have low BMD.”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [44] source
    • cites [45] source
    • cites [46] 1997, Journal of Clinical Endocrinology and Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [47] source

      The Abstract (page unavailable) says GHD is associated with low BMD, and the Discussion (page unavailable) identifies additional pituitary hormone deficiencies as possible predictors of lower BMD. The passages do not establish that patients in both the isolated-GHD and multiple-deficiency groups usually have low BMD; in particular, they provide no prevalence for either group. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [48] source
    • cites [49] 1999, The Journal of Clinical Endocrinology and Metabolism

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Scillitani et al. reported that the anabolic effect of GH excess on bone in acromegalic patients is gender independent, evident only at the spine in eugonadal patients regardless of disease activity, and present only at the femoral neck during active disease regardless of gonadal status.

    “Scillitani et al. reported that the anabolic effect of GH excess on bone in acromegalic patients is gender independent, evident only at the spine in eugonadal patients regardless of disease activity and present only at femoral neck during active disease regardless of gonadal status [36].”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Interpretationcitation

    The association between ACTH or TSH deficiency and lower BMD might be a consequence of either deficiencies of pituitary hormones or excessive hormone replacement.

    “might be a consequence of either deficiencies of pituitary hormones or excessive hormone replacement [47, 53, 54].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [47] source
    • cites [53] source
    • cites [54] source

  • May combine two claims.

    Premisecitation

    Glucocorticoids reduce replication and prevent terminal differentiation of bone-forming cells and promote apoptosis of osteoblasts and osteocytes by activating caspase 3.

    “GCs reduce replication and prevent the terminal differentiation of bone forming cells and additionally promote apoptosis of osteoblasts and osteocytes by activating caspase 3.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] source

  • May combine two claims.

    Premisecitation

    Glucocorticoid-induced osteoporosis occurs in two phases: a rapid early phase in which BMD is reduced by bone resorption, followed by a slower progressive phase in which BMD declines because of impaired bone formation.

    “GIO occurs in two phases, a rapid early phase in which BMD is reduced as a result of bone resorption, followed by a slower, progressive phase in which BMD declines because of impaired bone formation [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

  • May combine two claims.

    Premisecitation

    Patients with Cushing's syndrome may have lower BMD and increased osteoporotic fracture risk.

    “It is well known that patients with Cushing's syndrome may have lower BMD and increased osteoporotic fracture risk [6, 7, 9].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] source
    • cites [7] 2007, Netherlands Journal of Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [9] source

  • May combine two claims.

    Premisecitation

    Type of Cushing's syndrome, mean 24-hour serum cortisol level, and duration of symptomatic glucocorticoid overproduction had no influence on Z-scores.

    “Factors such as type of Cushing's syndrome, mean 24-hour serum level of cortisol, and duration of symptomatic glucocorticoid overproduction had no influence on Z-scores.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] 2007, Netherlands Journal of Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Factors associated with fracture risk in Cushing's syndrome include age at onset, span and severity of disease, and individual susceptibility to glucocorticoids.

    “Factors associated with fracture risk include age at the onset, span and severity of the disease, and individual susceptibility to GCs [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

  • May combine two claims.

    Premisecitation

    DXA is considered a gold-standard measurement of BMD, but it cannot assess bone microarchitecture, the most important factor in determining bone quality.

    “Although dual-energy X-ray absorptiometry (DXA) is considered a gold-standard measurement of BMD, it cannot be employed to assess bone microarchitecture, the most important factor in determining bone quality [10, 14].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] 2013, Clinical Endocrinology source
    • cites [14] source

  • May combine two claims.

    Premisecitation

    In adrenal incidentaloma patients with subclinical hypercortisolism, TBS is reduced and correlates with the number and severity of vertebral fractures and with the degree of cortisol excess.

    “Eller-Vainicher et al. showed that, in AI patients with subclinical hypercortisolism, TBS is reduced and correlates with the number and severity of vertebral fractures and with the degree of cortisol excess [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] source

  • May combine two claims.

    Premisecitation

    In adrenal incidentaloma patients, BMD was comparable between subjects with and without subclinical hypercortisolism, but the prevalence of vertebral fracture and spinal deformity index were significantly higher in those with subclinical hypercortisolism.

    “BMD in subjects with and without SH was comparable; however the prevalence of vertebral fracture and spinal deformity index (SDI) were significantly higher in SH subjects than in the group of patients without SH.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] source

  • May combine two claims.

    Premisecitation

    BMI and menstrual status did not show a correlation with Z-score in patients with Cushing's syndrome.

    “Body mass index (BMI) and menstrual status did not show a correlation with Z-score.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 2007, Netherlands Journal of Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    There was no significant difference in BMD between patients with Cushing's syndrome of different origins, neither in the whole group nor in male or female patients separately.

    “There was no significant difference in BMD between patients with Cushing's syndrome of different origins, neither in the whole group nor in male or female patients separately.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 2007, Netherlands Journal of Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In that study, BMD values were lower in the lumbar spine than in the femoral neck, although the difference was not statistically significant.

    “BMD values were lower in the lumbar spine than in the femoral neck, although the difference was not statistically significant.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 2007, Netherlands Journal of Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Subclinical hypercortisolism might cause osteoporosis and increased risk of vertebral fractures.

    “It is thought that even subclinical hypercortisolism (SH) might be the cause of osteoporosis and increased risk of vertebral fractures [3, 13].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] source
    • cites [13] source

  • May combine two claims.

    Premisecitation

    In functional GnRH deficiency, the pattern of GnRH secretion is altered, involving reduced frequency of pulsations and decreased pulse amplitude.

    “In cases of functional GnRH deficiency the pattern of GnRH secretion is altered, involving reduced frequency of pulsations and decreased pulse amplitude [4, 5].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] source
    • cites [5] source

  • May combine two claims.

    Premisecitation

    Hyperprolactinemia causes secondary hypogonadism and may have sex hormone-independent effects on bone metabolism.

    “Hyperprolactinemia causes secondary hypogonadism and may have sex hormone-independent effects on bone metabolism [17, 18].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] source
    • cites [18] source

  • May combine two claims.

    Premisecitation

    Endogenous hypercortisolism changes bone structure and causes vertebral fractures in up to 70% of patients.

    “Endogenous hypercortisolism changes bone structure and causes vertebral fractures in up to 70% of patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

  • May combine two claims.

    Premisecitation

    Glucocorticoids indirectly decrease production of insulin-like growth factors and shift transforming growth factor-beta binding.

    “Indirect actions of GCs involve decreased production of insulin-like growth factors (IGFs) and shifting transforming growth factor-β (TGF-β) binding [4, 5].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] source
    • cites [5] source

  • May combine two claims.

    Premisecitation

    Glucocorticoids decrease release of growth hormone and gonadotropins, which may play a role in bone turnover.

    “In addition, GCs decrease the release of growth hormone and gonadotropins which may also play a role in bone turnover [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 2007, Netherlands Journal of Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Normal or increased bone mass in acromegaly is attributable to the anabolic effect of GH, although BMD measurements may be overestimated due to structural modification of the spine.

    “Normal or increased bone mass is attributable to anabolic effect of GH, although BMD measurements may be overestimated due to structural modification of the spine [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] 2011, Clinical Cases in Mineral and Bone Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Dopamine agonist therapy restores gonadal function and increases vertebral BMD in most hyperprolactinemic women.

    “Dopamine agonist therapy restores gonadal function and increases vertebral BMD in most hyperprolactinemic women [19, 20].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [19] 1999, The Journal of Clinical Endocrinology and Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [20] source

  • May combine two claims.

    Premisecitation

    Patients with prolactinomas present with osteopenia or osteoporosis, and the risk factors for bone loss are disease duration and hypogonadism.

    “Authors reported that the patients with prolactinomas also presented with osteopenia or osteoporosis and the risk factors of bone loss were disease duration and hypogonadism [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

  • May combine two claims.

    Premisecitation

    Acromegaly is characterized by excessive growth hormone secretion and in most cases is caused by a somatotroph tumor of the pituitary gland.

    “Acromegaly is characterized by growth hormone (GH) excessive secretion and in most cases is caused by the presence of a somatotroph tumor of the pituitary gland [25, 26].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] source
    • cites [26] source

  • May combine two claims.

    Premisecitation

    After 6, 12, and 18 months of treatment, serum osteocalcin levels significantly increased and Ntx levels significantly decreased in the three groups of patients.

    “A progressive significant increase in serum OC levels and a significant decrease in Ntx levels were noted after 6, 12, and 18 months of treatment in the 3 groups of patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

  • May combine two claims.

    Premisecitation

    18-month treatment with bromocriptine, quinagolide, or cabergoline normalized serum PRL and osteocalcin levels and gonadal function, although it was unable to completely restore lumbar spine and femoral neck BMD and normalize Ntx levels.

    “18-month treatment with one of the dopamine agonists (bromocriptine, quinagolide, or cabergoline) normalized serum PRL and OC levels and gonadal function, although it was unable to completely restore lumbar spine and femoral neck BMD and normalize Ntx levels [20].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

  • May combine two claims.

    Premisecitation

    Increase in bone resorption and low BMD occur in males and females with hyperprolactinemia.

    “Increase in bone resorption and low BMD occur in males and females with hyperprolactinemia [18, 20–23].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [18] source
    • cites [20] source
    • cites [21] source
    • cites [22] source
    • cites [23] source

  • May combine two claims.

    Premisecitation

    Lumbar spine and femoral neck BMD values are negatively correlated with prolactin levels and disease duration in hyperprolactinemia.

    “A significant negative correlation was found between lumbar spine and femoral neck BMD values and both prolactin (PRL) levels and disease duration, which suggests that the duration of the disease is strongly correlated with the severity of bone loss [20, 22].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [20] source
    • cites [22] source

  • May combine two claims.

    Premisecitation

    In the prepubertal period, the anabolic action of GH is responsible for longitudinal bone growth; during adolescence and early adulthood it induces skeletal maturation until peak bone mass is achieved; in adulthood GH regulates bone turnover, maintaining bone mass.

    “In prepubertal period anabolic action of GH is responsible for longitudinal bone growth, whereas during the adolescence and early adulthood it induces skeletal maturation until the achievement of peak bone mass. In adulthood GH regulates bone turnover, thus maintaining bone mass [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] 2011, Clinical Cases in Mineral and Bone Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In hyperprolactinemic males, low BMD at the lumbar spine was found in 80% of patients, whereas only 30% had reduced BMD at the femoral neck; a similar finding was reported in women.

    “A study on hyperprolactinemic males showed low BMD at the lumbar spine in 80% of patients, whereas only 30% subjects had a reduced BMD at the femoral neck. Similar finding was reported in women [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

  • May combine two claims.

    Premisecitation

    GH and IGF-1 stimulate proliferation, differentiation, and extracellular matrix production in osteoblastic cells, and also promote osteoclast recruitment and bone resorption activity.

    “GH and its main peripheral mediator insulin-like growth factor-1 (IGF-1) stimulate proliferation, differentiation, and extracellular matrix production in osteoblastic cells. GH and IGF-1 also promote osteoclast recruitment and bone resorption activity [27–30].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [27] 2011, Clinical Cases in Mineral and Bone Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [28] source
    • cites [29] 1993, Journal of Clinical Endocrinology and Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [30] source

  • May combine two claims.

    Premisecitation

    Males with prolactinomas who suffered fractures had lower BMD T-score and longer duration of disease, independently of age, serum IGF-1 and PRL values, frequency of macroadenomas, adrenal insufficiency, hypothyroidism, diabetes insipidus, parental history of fractures, cigarette smoking, and excessive alcohol consumption.

    “Males with prolactinomas who suffered fractures had lower BMD T-score and longer duration of the disease, independently of the effects of age, serum IGF-1 and PRL values, frequency of macroadenomas, adrenal insufficiency, hypothyroidism, diabetes insipidus, parental history of fractures, cigarette smoking, and excessive alcohol consumption [18].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] source

  • May combine two claims.

    Premisecitation

    In one study, all patients had significantly lower osteocalcin levels and significantly higher urinary Ntx levels, but BMD values were in normal ranges in 20% of the patients.

    “In one study, in all patients, osteocalcin (OC) levels were significantly lower and urinary cross-linked N-telopeptide of type I collagen (Ntx) levels were significantly higher; however BMD values were in normal ranges in 20% of the patients [20].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

  • May combine two claims.

    Premisecitation

    Patients with acromegaly generally demonstrate increased cortical bone mass, whereas trabecular BMD is more variable.

    “Patients with acromegaly generally demonstrate increased cortical bone mass, whereas trabecular BMD is more variable [23, 35, 41, 42].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [23] source
    • cites [35] 1993, Journal of Bone and Mineral Research source
    • cites [41] source
    • cites [42] source

  • May combine two claims.

    Premisecitation

    Fractures are more severe and often multiple in men with acromegaly.

    “They are also more severe and often multiple in men [27, 42].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] 2011, Clinical Cases in Mineral and Bone Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [42] source

  • May combine two claims.

    Interpretationcitation

    The rise in serum calcium levels in active acromegaly may be caused by increased intestinal calcium absorption, while high serum phosphate levels may be due to GH-mediated increased intestinal and renal absorption.

    “Rise in serum calcium levels may be caused by increased intestinal calcium absorption, while high serum phosphate levels may be due to GH-mediated increased intestinal and renal absorption [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] 2011, Clinical Cases in Mineral and Bone Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Patients with acromegaly have an increased risk of fractures, which might be correlated with insufficient quality of bone.

    “Patients with acromegaly have an increased risk of fractures, which might be correlated with insufficient quality of bone [26, 27, 39, 42].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [26] source
    • cites [27] 2011, Clinical Cases in Mineral and Bone Metabolism

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [39] source
    • cites [42] source

  • May combine two claims.

    Interpretationcitation

    Abnormal bone quality persists after remission in biochemically controlled acromegaly, possibly due to pretreatment long-term exposure to high circulating levels of GH.

    “This is suggestive of an abnormal bone quality persisting after remission, possibly due to pretreatment long-term exposure to high circulating levels of GH [30].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] source

  • May combine two claims.

    Premisecitation

    In one study, forearm and vertebral BMD values changed in opposite directions; forearm BMD was increased because of GH and IGF-1 action and vertebral BMD was low due to hypogonadism.

    “In one study, forearm and vertebral BMD values changed in opposite directions. It seems that forearm BMD was increased because of GH and IGF-1 action and vertebral BMD was low due to hypogonadism [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] source

  • May combine two claims.

    Premisecitation

    The axial skeleton is composed of 70% trabecular bone, while the appendicular skeleton is composed of 90% cortical bone.

    “Axial skeleton is composed of 70% trabecular bone, while appendicular skeleton of 90% cortical bone [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] source

  • May combine two claims.

    Premisecitation

    After the first phase of GH treatment, bone turnover slows down and bone mass increases.

    “After this period bone turnover slows down and bone mass increases [48, 57, 58].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [48] source
    • cites [57] source
    • cites [58] source

  • May combine two claims.

    Premisecitation

    In a nationwide study of patients with GHD, the risk of fracture was significantly increased in adult onset GHD females, but not in males.

    “In one nationwide study of patients suffering from GHD the risk of fracture was significantly increased in adult onset (AO) GHD females, but not in males.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The doses of rhGH used in studies varied from 0.2 to 0.96 mg/daily, with higher doses prescribed to women and patients with CO GHD.

    “The doses used in studies varied from 0.2 to 0.96 mg/daily with higher doses prescribed to women and patients with CO GHD [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] source

  • May combine two claims.

    Premisecitation

    The beneficial effect of rhGH replacement therapy on BMD is affected by gender, age, and treatment duration.

    “This beneficial effect of rhGH replacement therapy is affected by gender, age, and treatment duration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] source

  • May combine two claims.

    Interpretationcitation

    The findings on fracture incidence in GHD patients on complete hormone replacement therapy are justified by the interaction between oral estrogen and the GH-IGF-1 axis in women and by the adequate substitution of testosterone and GH in men.

    “These findings were justified by the interaction between oral estrogen and the GH-IGF-1 axis in women and by the adequate substitution of testosterone and GH in men [44].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] source

  • May combine two claims.

    Premisecitation

    GHD and hypopituitarism are associated with increased fracture risk.

    “It has been reported that GHD and hypopituitarism are associated with increased fracture risk [17, 44, 51, 55].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [17] source
    • cites [44] source
    • cites [51] source
    • cites [55] source

  • The quote only partly states this claim.

    Premisecitation

    Similar outcomes (significant increase in BMD) were observed in prospective studies of rhGH administration.

    “Similar outcomes were observed in prospective studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] source

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Secondary osteoporosis and fragility fractures can be a result of Cushing's syndrome, hyperprolactinemia, acromegaly, and reduced production of sex steroids (hypogonadism).

    “Secondary osteoporosis and fragility fractures can be a result of Cushing's syndrome, hyperprolactinemia, acromegaly, and reduced production of sex steroids (hypogonadism).”
    Quote in the paperNot a substantial claim
49 of 49

  • The paper relies on this without support.

    The final bone effects of pituitary-dependent and adrenal-dependent Cushing's syndrome are caused by hypercorticism.

    “In current review we discuss both pituitary-dependent Cushing's syndrome (Cushing's disease) and adrenal-dependent Cushing's syndrome, since the final bone effects of both are caused by hypercorticism.”

  • The paper relies on this without support.

    Glucocorticoid-induced osteoporosis is the most common cause of secondary osteoporosis.

    “Glucocorticoid-induced osteoporosis (GIO) is the most common cause of secondary osteoporosis.”

  • The paper relies on this without support.

    Vertebral fractures are often asymptomatic and are largely underdiagnosed.

    “VFs are often asymptomatic and are largely underdiagnosed.”
3 of 3

Cites

Flagged first, then by citations

2 of the 62 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. 2007, Netherlands Journal of Medicine, 65, 137
  2. 1999, The Journal of Clinical Endocrinology and Metabolism, 84, 1775
  3. 2011, Clinical Cases in Mineral and Bone Metabolism, 8, 37
  4. 1993, Journal of Clinical Endocrinology and Metabolism, 76, 1452
  5. 1997, Journal of Clinical Endocrinology and Metabolism, 82, 1462
  6. 1999, The Journal of Clinical Endocrinology and Metabolism, 84, 1919

Cited by

Sorted by citations

Related

Authors
Bolanowski, M., Halupczok, J., & Jawiarczyk-Przybyłowska, A.
Affiliations
  • Wroclaw Medical University (PL)
  • Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Pasteura 4, 50-367 Wroclaw, Poland
Corresponding author
Bolanowski, Marek
ORCID
Venue
International Journal of Endocrinology
Publisher
Wiley
Published
2015
Volume
2015
Pages
1-7
ISSN
  • 1687-8337 (ISSN-L)
  • 1687-8345
DOI
10.1155/2015/206853
PMC
PMC4383139
OpenAlex
W2001678032
Cited by
27
References
62
Citations by year
2026: 4 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 1
FWCI
2.17
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Endocrinology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
Keywords
pituitary disorders, secondary osteoporosis, bone metabolism, fracture risk, Cushing's disease, hyperprolactinemia, acromegaly, hypopituitarism, hypogonadism

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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