The DOI matches its Crossref record; 669 of the 669 references it cites were found in a registry or an index; 2 of the 135 sources its claims cite were checked for support.
Pituitary Diseases and Bone
Open accessAbstract
Neuroendocrinology of bone is a new area of research based on the evidence that pituitary hormones may directly modulate bone remodeling and metabolism. Skeletal fragility associated with high risk of fractures is a common complication of several pituitary diseases such as hypopituitarism, Cushing disease, acromegaly, and hyperprolactinemia. As in other forms of secondary osteoporosis, pituitary diseases generally affect bone quality more than bone quantity, and fractures may occur even in the presence of normal or low-normal bone mineral density as measured by dual-energy X-ray absorptiometry, making difficult the prediction of fractures in these clinical settings. Treatment of pituitary hormone excess and deficiency generally improves skeletal health, although some patients remain at high risk of fractures, and treatment with bone-active drugs may become mandatory. The aim of this review is to discuss the physiological, pathophysiological, and clinical insights of bone involvement in pituitary diseases.
Overview
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Written from the paper’s full text.
TL;DR
Pituitary hormone excess or deficiency commonly causes skeletal fragility, often with fractures despite normal or low-normal bone mineral density by DXA. This narrative review synthesizes mechanisms and clinical evidence across acromegaly, prolactinoma, Cushing disease, TSH-oma, and hypopituitarism, emphasizing morphometric vertebral assessment and the limits of BMD for fracture prediction.
Key findings
- Vertebral fractures are a frequent complication of pituitary diseases; DXA does not reliably predict fracture risk, and morphometric vertebral assessment is currently the mainstay for skeletal evaluation.
- In acromegaly, the overall median prevalence of vertebral fractures is ~40%, with fracture risk threefold to eightfold higher than controls; a prospective study found incident vertebral fractures in 42% of patients over 3 years, related to active disease and duration.
- In prolactinoma, radiological vertebral fractures occurred in 32.6% of women (25/78) and 37.5% of men; 80% of male patients had osteopenia or osteoporosis at the lumbar spine, whereas only 30% had low femoral neck BMD.
- In Cushing disease, DXA osteoporosis prevalence is 28% to 50%, fracture prevalence 15% to 50%, and morphometric vertebral fracture prevalence 78%; in growth hormone deficiency, fracture risk is twofold to fivefold higher, more than 60% of adults had vertebral fractures in one study, and after 6 years untreated GHD had a sevenfold higher risk of vertebral fractures than treated GHD.
Methods
- Narrative review of physiological, pathophysiological, and clinical literature on bone involvement in pituitary diseases, including hypopituitarism, Cushing disease, acromegaly, and hyperprolactinemia.
- Synthesizes experimental, observational, cross-sectional, prospective, and meta-analytic evidence; includes tables of studies evaluating fragility fractures and bone structure in acromegaly, prolactinoma, Cushing disease, and hypopituitarism.
- No new primary patient data or systematic review methodology are reported.
Limitations
- Stated: no specific guidelines have been published on monitoring skeletal health in pituitary diseases, so monitoring cannot be evidence based; no randomized controlled trials evaluate rhGH effects on fracture risk; no studies have tested antiosteoporotic drugs in acromegaly; clinical relevance of IGFBP skeletal effects and FSH effects in humans remains unclear.
- Evident from the text: as a narrative review, it does not use a systematic search or formal meta-analysis, and many cited fracture studies are cross-sectional or retrospective, with heterogeneous designs and endpoints.
- Evident from the text: DXA limitations are repeatedly noted, including inability to capture bone quality, microstructure, and compartment-specific changes, which affects fracture prediction in these populations.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
2 of 135 cited sources checked · 2 supported · 0 flagged
Every source the paper cites for this claim was checked and supports it.
In the paper
“Significant reductions were also observed in cortical area fraction and cortical thickness at the femur midshaft.”
§ Pituitary Diseases and Bone > Skeletal effects of GH, IGF-I, and IGFPBs
What the sources say
- Supportedcites [155] Maridas, 2017, IGFBP-4 regulates adult skeletal growth in a sex-specific manner, J Endocrinol source
The Results section, “Gender-specific bone phenotype Igfbp4−/− mice,” reports significant reductions in both cortical area fraction and cortical thickness at the femur midshaft in 16-week-old Igfbp4−/− females compared with littermate controls. (LLM, conf=0.95)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, in this study baseline TBS was normal.”
§ Pituitary Diseases and Bone > Effects of rhGH on BMD.
What the sources say
- Supportedcites [449] Allo Miguel, 2016, Seven years of follow up of trabecular bone score, bone mineral density, body composition and quality of life in adults with growth hormone deficiency treated with rhGH replacement in a single center, Ther Adv Endocrinol Metab source
The Discussion explicitly states that baseline TBS was normal in this study. The BMD and TBS section also reports a baseline mean of 1.36 ± 0.11, which it describes as in the upper normal range. (LLM, conf=0.95)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“likely reflecting the impossibility of questionnaires and databases to correctly identify VFs ().”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Increased bone formation seen in vivo was likely due to the coupling of bone formation to bone resorption, which was absent in in vitro conditions.”
§ Pituitary Diseases and Bone > Skeletal effects of PRL
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Despite the stimulating effects of GH and IGF-I on renal activation of vitamin D (), hypovitaminosis D has been consistently reported in patients with acromegaly (, ), and there is also evidence suggesting lower peripheral bioavailability of vitamin D in this clinical setting as an effect of an increase in vitamin D binding protein (, ).”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These effects on the RANKL-OPG axis may explain the differential effect of short vs prolonged exposure to PTH with respect to the balance of its anabolic and catabolic actions.”
§ Pituitary Diseases and Bone > PTH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, the current experimental observations suggest that most of the effects of GH on bone are mediated by IGF-I.”
§ Pituitary Diseases and Bone > Skeletal effects of GH, IGF-I, and IGFPBs
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, there has been growing evidence to suggest that pituitary hormones may bypass traditional endocrine organs to exert remarkable direct effects on the skeleton.”
§ Pituitary Diseases and Bone > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes? Based: unclearNone of the sources cited for this claim have been checked yet.
In the paper
“In several clinical studies, serum TSH values in the reference range were associated with BMD and fractures.”
§ Pituitary Diseases and Bone > Skeletal effects of TSH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In fact, DXA measurement of BMD does not provide information on bone quality, which depends on bone macrostructure, microstructure, mineralization, microdamage, and collagen status.”
§ Pituitary Diseases and Bone > Clinical Skeletal Endpoints and Diagnostic Tools
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- It may state two separate claims as one. 76
- Probably not a substantial claim. 11
- The quote only partly states this claim. 2
None of the sources cited for this claim have been checked yet.
In the paper
“In a meta-analysis performed in studies (, , , , -), acromegaly did not induce a significant change in BMD at the lumbar spine, whereas BMD was increased at the femoral neck and total hip ().”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“fractures may occur even in the presence of normal or lownormal bone mineral density as measured by dual-energy X-ray absorptiometry, making difficult the prediction of fractures in these clinical settings.”
§ Pituitary Diseases and Bone > Abstract
What the sources say
- Not checked — no full text of the sourcecites [1] Mazziotti, 2015, Pituitary diseases and bone, Endocrinol Metab Clin North Am source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“The beneficial effects of alendronate on BMD were accompanied by a decrease in VF incidence, although the study was not powered for this endpoint.”
§ Pituitary Diseases and Bone > Treatment With Bone-Active Agents in Pituitary Diseases
What the sources say
- Not checked — no full text of the sourcecites [612] Biermasz, 2004, Long-term skeletal effects of recombinant human growth hormone (rhGH) alone and rhGH combined with alendronate in GH-deficient adults: a seven-year follow-up study, Clin Endocrinol (Oxf) source
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The bisphosphonate, administered up-front in six GHD patients treated with rhGH, attenuated the increase in bone turnover and prevented the decline in BMD eventually observed in the first months of GH substitutution.”
§ Pituitary Diseases and Bone > Treatment With Bone-Active Agents in Pituitary Diseases
What the sources say
- Not checked — no full text of the sourcecites [609] Valk, 1995, Combined treatment of growth hormone and the bisphosphonate pamidronate, versus treatment with GH alone, in GH-deficient adults: the effects on renal phosphate handling, bone turnover and bone mineral mass, Clin Endocrinol (Oxf) source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“particularly in the presence of reduced BMD, a finding that is not so frequent in patients with acromegaly.”
§ Pituitary Diseases and Bone > Treatment With Bone-Active Agents in Pituitary Diseases
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, DXA measurement of BMD in acromegaly could be influenced by the bone enlargement caused by GH excess (), although the effects on bone mineral content seem to overcome those on bone area ().”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Hyperfunctioning pituitary diseases are caused by pituitary adenomas.”
§ Pituitary Diseases and Bone > Pituitary Diseases and Skeletal Endpoints
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this model a prevalent role of TSH in driving fracture risk may be hypothesized in the presence of normal thyroid hormone levels.A less relevant role for TSH may be suggested when thyroid hormones rise above the normal levels.”
§ Pituitary Diseases and Bone > Skeletal effects of TSH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“At the femoral neck, volumetric BMD, bone volume fraction, and Tb.N were also strikingly increased.”
§ Pituitary Diseases and Bone > Skeletal effects of FSH
What the sources say
- Not checked — no full text of the sourcecites [198] Sun, 2006, FSH directly regulates bone mass, Cell source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“DXA does not distinguish between cortical and trabecular bone, and densitometric results are greatly influenced by the variable distribution of these two compartments in the different skeletal sites ().”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When PRL values are very high, bone resorption is further stimulated, whereas bone formation is suppressed with consequent impairment of trabecular bone microstructure.”
§ Pituitary Diseases and Bone > Skeletal effects of PRL
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The hypercalciuria observed in acromegaly patients is classically linked to increased intestinal calcium absorption driven by calcitriol, as well as to the increased bone turnover induced by GH excess ().”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Of note, these effects were independent of thyroid hormones because the women did not have a thyroid gland, and replacement therapy with L-thy- roxine was stable during the study period.”
§ Pituitary Diseases and Bone > Skeletal effects of TSH
What the sources say
- Not checked — no full text of the sourcecites [257] Mazziotti, 2005, Recombinant human TSH modulates in vivo C-telopeptides of type-1 collagen and bone alkaline phosphatase, but not osteoprotegerin production in postmenopausal women monitored for differentiated thyroid carcinoma, J Bone Miner Res source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, PRL exerts direct actions on bone remodeling with effects that were shown to be dependent on the circulating hormone values and influenced by the effects of sex hormones and calcium supply.”
§ Pituitary Diseases and Bone > Skeletal effects of PRL
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In fact, pathologically high GH and IGF-I levels exert a deleterious effect on trabecular microarchitecture, whereas cortical bone density tends to be increased as an effect of GH on periostal ossification ().”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Patients with active acromegaly frequently have phosphate and calcium abnormalities, such as mild hyperphosphatemia, a tendency toward increased plasma calcium levels, and hypercalciuria independently of PTH (, ).”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When PRL values increase in the range of mild hyperprolactinemia, bone remodeling is further stimulated, with bone resorption increasing more than bone formation.”
§ Pituitary Diseases and Bone > Skeletal effects of PRL
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Interestingly, VFs developed more frequently at the thoracic spine and they were most commonly anterior wedge fractures (), possibly contributing to kyphosis of patients with acromegaly, a feature clearly present in the first patients reported by Pierre-Marie ().”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Bonadonna et al. () identified for the first time VFs in ~% of postmenopausal women with acromegaly, although densitometric osteoporosis was present in ,% of the entire population.”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Incident VFs developed in % of patients with acromegaly during a -year follow-up, in close relationship with baseline disease status (i.e., higher incidence in patients with active acromegaly) and duration of active disease.”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In another study performed in patients with long-standing controlled acromegaly, deletion of exon- of GHR was associated with higher prevalence of colonic polyps, dolichocolon, and osteoarthritis, without any significant impact of GHR polymorphism on BMD and vertebral and nonvertebral fractures ().”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The elevated plasma phosphate concentrations are related both to increased calcitriol-stimulated dietary phosphate absorption and to a direct antiphosphaturic action of IGF-I in the proximal renal tubule, whereas it is uncertain whether hyperphosphatemia may correlate with high bone turnover (, ).”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, the increase of OPG may realize a feed-forward loop inhibiting osteoclastogenesis.”
§ Pituitary Diseases and Bone > Skeletal effects of TSH
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Other cross-sectional studies confirmed these findings (, , , ), and the overall median prevalence of VFs was calculated to be ~%, with a fracture risk that was threefold to eightfold higher in acromegaly patients as compared with control subjects ().”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, there is evidence that TSH may directly inhibit osteoclastogenesis and bone resorption, with concomitant increase in bone formation when hormone exposure is intermittent.”
§ Pituitary Diseases and Bone > Skeletal effects of TSH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The abovementioned cross-sectional studies were not able to define the causal relationship between GH hypersecretion and VFs and did not provide reliable information on the clinical predictors of fractures in this clinical setting.”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The clinical relevance of this effect in humans is still largely uncertain, because patients with central hypogonadism are at high risk of bone loss notwithstanding low FSH values”
§ Pituitary Diseases and Bone > Skeletal effects of FSH
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most patients with acromegaly show normal or even increased BMD at various skeletal sites, and osteopenia and osteoporosis are not common features in acromegaly.”
§ Pituitary Diseases and Bone > GH-secreting adenoma in adults (acromegaly)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There are no clinical studies specifically evaluating the direct effects of PRL at different concentrations, because in most cases the relative contributions of PRL excess and sex steroid deficiency are difficult to be discriminated.”
§ Pituitary Diseases and Bone > Skeletal effects of PRL
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Polymorphism of GHR, characterized by deletion of exon- with consequent higher sensitivity to GH, was associated with a higher prevalence of VFs in patients with acromegaly (), with stronger association in females as compared with males ().”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Patients with TSH-oma with persistent hyperthyroidism after neurosurgery can be treated with firstgeneration SRLs that can normalize TSH and thyroid hormone levels in .% of patients and reduce tumor size in .% of patients ().”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Besides the abnormalities in trabecular microstructure, acromegaly was shown to also affect cortical bone in terms of increased porosity (, , ) and impaired cortical strength ().”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In patients with untreated GHD, VFs were associated with BMD, because the highest risk to develop fractures was found in patients with a T score below 2. SD ().”
§ Pituitary Diseases and Bone > Bone Density and Quality as Predictors of Fractures in Pituitary Diseases
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“In clinical trials, octreotide LAR and lanreotide autogel have been reported to normalize GH and IGF-I in half to two-thirds of patients (), whereas success rate was shown to be lower in surveys involving nonselected cohorts of patients ().”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“remission of pituitary hyperfunction can be achieved in % to % of patients with microadenomas and % to % of those with macroadenomas, with a % to % of recurrence rate over several years (, ).”
§ Pituitary Diseases and Bone > Therapeutic options
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of note, the prevalence of VFs in postmenopausal women was higher as compared with control women of comparable age, in close relationship with the duration of hyperprolactinemia (OR, .; % CI, . to .) but not with the age of onset of hyperprolactinemia (OR, .; % CI, . to .).”
§ Pituitary Diseases and Bone > PRL-oma
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Dopamine agonists are the first-line therapy of PRL-oma because they may normalize PRL values, decrease tumor mass, and improve clinical symptoms in most patients (, ).”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, PRL-oma causes high bone turnover osteoporosis, with low BMD occurring in most patients, especially when the disease develops in the first decades of life before the achievement of peak bone mass.”
§ Pituitary Diseases and Bone > PRL-oma
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In fact, such a finding may reflect different severity of acromegaly in patients treated with the two drugs.”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated acromegaly
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“The annual fracture rate was .% before and .% after diagnosis among the patients with PRL-oma, and .% and .%, respectively, among their controls ().”
§ Pituitary Diseases and Bone > PRL-oma
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The first study was carried out in women ( were premenopausal and were in the postmenopausal period) who were evaluated for VFs using quantitative morphometry ().Radiological VFs were found in out of these women (.%), with the prevalence being higher in postmenopausal women ( of ) as compared with premenopausal women ( of ).”
§ Pituitary Diseases and Bone > PRL-oma
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In Cushing's original series of patients published in , radiographic osteoporosis was reported in patient, patients were reported to have kyphosis, and were reported to have spontaneous fractures.”
§ Pituitary Diseases and Bone > ACTH-secreting adenoma (Cushing disease)
Strength:plain· not yet calibratedn = 12Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Hong et al. () found a % lower TBS in males and females with acromegaly as compared with control subjects, without any significant difference in BMD.”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“TBS was shown to be deteriorated more than BMD, but both the parameters were not associated with fractures ().”
§ Pituitary Diseases and Bone > Bone Density and Quality as Predictors of Fractures in Pituitary Diseases
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Monitoring of mifepristone treatment can be difficult because ACTH and cortisol levels increase rather than decrease, and overdosing causing adrenal insufficiency can occur ().”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Bone turnover is invariably increased in patients with active acromegaly, whereas BMD as measured by DXA is generally slightly decreased or even normal.”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“These studies did not show any difference in BMD between the two groups, although the heterogeneity was too high to achieve conclusions in this regard ().”
§ Pituitary Diseases and Bone > Bone Density and Quality as Predictors of Fractures in Pituitary Diseases
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Carbergoline was shown to be more effective in normalizing PRL values, with fewer side effects, as compared with bromocriptine ().”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, it is possible to hypothesize that bone loss in patients with hypeprolactinemia may be synergistically determined by increased PRL levels per se and by the concomitant sex hormone deprivation.”
§ Pituitary Diseases and Bone > PRL-oma
Tests✗ Asserted: fails✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. The authors may not put it forward as true.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients with PRL-oma are predisposed to develop osteopenia, osteoporosis, and fragility fractures as an effect of hypogonadism induced by PRL excess, as well as an effect of direct actions of PRL on bone cells and calcium metabolism ().”
§ Pituitary Diseases and Bone > PRL-oma
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In a prospective study, incident VFs were reported to occur more frequently during treatment with pegvisomant as compared with SRLs ().”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated acromegaly
What the sources say
- Not matchedcites ()
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“Currently available adrenal steroidogenesis inhibitors, including ketoconazole, metyrapone, etomidate, and mitotane, have variable efficacy and significant side effects, but they are not approved by the US Food and Drug Administration for CD ().”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Indeed, skeletal fragility is a frequent complication of endogenous hypercortisolism, and fragility fractures may be the presenting clinical feature of disease (, ).”
§ Pituitary Diseases and Bone > ACTH-secreting adenoma (Cushing disease)
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, there is consistent evidence that GH excess causes deterioration of bone microstructure leading to high risk of VFs in close relationship with duration of active acromegaly.”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pathogenesis of PRL-oma-induced bone loss is multifactorial, because both direct and indirect (hypogonadism) skeletal effects of hyperprolactinemia may be involved.”
§ Pituitary Diseases and Bone > PRL-oma
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“all untreated patients with osteoporosis (T score # 2. SD) and all but one patient with osteopenia (T score between 2. and 2. SD) had VFs.”
§ Pituitary Diseases and Bone > Bone Density and Quality as Predictors of Fractures in Pituitary Diseases
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“The bone loss was more pronounced at the lumbar spine and femoral neck, consistent with the view that trabecular bone is a principal target for the detrimental actions of glucocorticoid excess in the skeleton (, , -).”
§ Pituitary Diseases and Bone > ACTH-secreting adenoma (Cushing disease)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Neurosurgery is the first-line therapy of CD (), acromegaly (, ), and TSH-oma ().”
§ Pituitary Diseases and Bone > Therapeutic options
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the evaluation of bone microstructure may provide some reliable information on the risk of fractures”
§ Pituitary Diseases and Bone > Bone Density and Quality as Predictors of Fractures in Pituitary Diseases
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
In the paper
“Pegvisomant is a pegylated recombinant GH analog designed to interfere with dimerization of GHR and thus blocks production of IGF-I () without any direct effect on pituitary tumor.”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“VFs occurred even in patients with normal BMD, especially when acromegaly was active ()”
§ Pituitary Diseases and Bone > Bone Density and Quality as Predictors of Fractures in Pituitary Diseases
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“In another uncontrolled study performed in naive patients with active acromegaly, TBS was found to be partially degraded according to the definition by the manufacturer, whereas BMD z scores in most compartments did not differ from ().”
§ Pituitary Diseases and Bone > Morphometric VFs-prevalence.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Interestingly, the prevalence of VFs was not significantly different between eugonadal and”
§ Pituitary Diseases and Bone > PRL-oma
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“In the second crosssectional study, radiological VFs were found in .% of male patients with PRL-oma, with the prevalence being about fivefold higher as compared with control subjects ().”
§ Pituitary Diseases and Bone > PRL-oma
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“In patients with pituitary diseases, the experience with these algorithms is limited (, ), with inconclusive results concerning the reliability in predicting fractures in this clinical setting.”
§ Pituitary Diseases and Bone > Bone Density and Quality as Predictors of Fractures in Pituitary Diseases
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“This biochemical effect was accompanied by variable changes in BMD (, , , , , , , ) and with persistently abnormal bone structure (, ).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated acromegaly
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Mifepristone is a glucocorticoid receptor antagonist that improves glucose tolerance, body weight, and quality of life in CD ().”
§ Pituitary Diseases and Bone > Medical therapies.
What the sources say
- Not matchedcites
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Eighty percent of male patients with PRL-oma were found to have densitometric diagnosis of either osteopenia or osteoporosis at the lumbar spine, whereas only a minority of them (%) showed a low BMD at the femoral neck, suggesting that trabecular bone was damaged earlier than cortical bone (, , ).”
§ Pituitary Diseases and Bone > PRL-oma
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In some studies, BMD was correlated with PRL levels, biochemical markers of bone turnover, and duration of disease, but not with serum testosterone values in males () or estradiol values and coexistent amenorrhea in women ().”
§ Pituitary Diseases and Bone > PRL-oma
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The increase in BMD was larger and occurred earlier at the lumbar spine as compared with the total hip (, ).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites (, )
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Changes in BMD after the cure of CD are time-dependent and skeletal site specific.”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In a retrospective analysis, no incident clinical fractures were registered during a period of years after the cure of hypercortisolism, although the number of patients with long-term follow-up was too low to draw definitive conclusions ().”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites ()
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“In fact, Vestergaard et al. () reported a significant decrease in risk of clinical fractures early after diagnosis of CD (Table ), although it was not specified whether this outcome was related to correction of hypercortisolism or to other treatments (e.g., sex steroids or vitamin D) potentially impacting fracture risk in this clinical setting (-).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites ()
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Alternatively, a high prevalence of VFs was reported in patients with long-standing cured CD (Table ), although the cross-sectional design did not allow definition of the timing of fracture development and progression in relationship to the outcome of hypercortisolism ().”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites ()
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Of note, patients with previous fractures were predisposed to develop new fractures after treatment of CD (), confirming that fractures are a hallmark of skeletal fragility in CD such as observed in other pituitary diseases (, ).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites (, )
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“These changes in bone turnover are expected to be associated with an increase in BMD, although the densitometric outcomes after treatment of hypercortisolism were shown to be variable, with some patients recovering normal BMD (, ) and others showing persistently abnormal BMD for several years after the cure of CD (, -).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites (, )
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites (, -)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In fact, although HR-pQCT is apparently the gold standard in the arena, its costs make its availability for routine evaluation unrealistic.”
§ Pituitary Diseases and Bone > Future Directions and Conclusions
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Another so far almost unexplored territory is the role of bone-active drugs in the treatment of bone complications in pituitary diseases.”
§ Pituitary Diseases and Bone > Future Directions and Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“rhGH is antiphosphaturic and increases the intestinal absorption of phosphate, leading to an increase in serum phosphate levels (-).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated GHD
What the sources say
- Not matchedcites (-)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“The close association between fragility fractures and severity of hypercortisolism () and duration of disease () suggests that an early treatment of CD may have a favorable impact on fracture risk ().”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites ()
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites ()
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In fact, although HR-pQCT is apparently the gold standard in the arena, its costs make its availability for routine evaluation unrealistic.”
§ Pituitary Diseases and Bone > Future Directions and Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“The effect of rhGH on bone remodeling is biphasic; that is, rhGH causes a maximal effect on bone resorption after months and on bone formation after months.”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated GHD
What the sources say
- Not matchedcites (, , -)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“rhGH causes an increase in serum and urinary calcium after to months, an effect caused by calcium mobilization from the skeleton, an increase in intestinal calcium absorption, and in the renal reabsorption of calcium due to increased sensitivity to PTH (-).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated GHD
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“L-T doses in central hypothyroidism average . mg/kg/d, based on the evidence that this hormone dose was associated with an improvement in several clinical endpoints of central hypothyroidism (-).”
§ Pituitary Diseases and Bone > Therapeutic options
What the sources say
- Not matchedcites (-)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“BMD values, however, only partially improved during treatment, remaining still lower as compared with normal control subjects (, -, , -).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites (, -, , -)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Correction of hypercortisolism was accompanied by a marked increase in osteocalcin levels and moderate increase or even decrease in NTX levels (, ).”
§ Pituitary Diseases and Bone > Skeletal endpoints in treated PRL-oma
What the sources say
- Not matchedcites (, )
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
The paper relies on this without support.
Skeletal fragility associated with high risk of fractures is a common complication of hypopituitarism, Cushing disease, acromegaly, and hyperprolactinemia.
“Skeletal fragility associated with high risk of fractures is a common complication of several pituitary diseases such as hypopituitarism, Cushing disease, acromegaly, and hyperprolactinemia.”
The paper relies on this without support.
The control groups in the cited studies are appropriate comparators for patients with pituitary disease.
“as compared with control subjects”
The paper relies on this without support.
The fracture definitions used in the cited studies accurately identify fragility fractures.
“radiological VFs were found”
The paper relies on this without support.
Bisphosphonates inhibit bone resorption.
“Bisphosphonates inhibit bone resorption and are the most commonly prescribed drugs for the treatment of osteoporosis.”
The paper relies on this without support.
Bisphosphonates may potentially delay the recovery of bone remodeling after resolution of endogenous hypercortisolism.
“In fact, it should be considered that bisphosphonates may potentially delay the recovery of bone remodeling after resolution of endogenous hypercortisolism.”
The paper relies on this without support.
Pituitary diseases are burdened by relevant osteometabolic derangements.
“Pituitary diseases are burdened by relevant osteometabolic derangements.”
The paper relies on this without support.
For mainly economic reasons, substitution with rhGH has become progressively less popular in our health systems and among endocrinologists.
“For mainly economic reasons the substitution with rhGH has become progressively less popular in our health systems and among endocrinologists.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Four GHD drug studies are called alendronate studies, but one used pamidronate
MinorOf the four GHD studies discussed immediately afterward and listed in Table 5, the Valk study used pamidronate rather than alendronate.
“Four studies evaluated the efficacy of alendronate in hypopituitary patients with GHD (Table ).”
“| Valk et al., 1995 | Prospective | GHD | 6 (50% F) | 0/6 | Pamidronate | 6 | ↑LS BMC in GHD treated with rhGH plus |”
The same PRL model is described as having both unchanged and decreased BMD
MinorThe description of the experimental model first says BMD was not altered, then refers to a decrease in BMD in that model.
“In this experimental model, BMD and bone mineral content were not altered”
“which also explained the decrease in BMD observed in this model.”
Citations
Cites
Items 201–400 of 669
Clinical, quality of life, and economic value of acromegaly disease control
Ben-Shlomo, A., Sheppard, M. C., Stephens, J., Pulgar, S. J., & Melmed, S. K. (2011) · Pituitary · doi:10.1007/s11102-011-0310-7 · Cited by 160
Abnormal body composition and reduced bone mass in growth hormone deficient hypopituitary adults*
Beshyah, S., Freemantle, C., Thomas, E. L., Rutherford, O. M., Page, B. C., Murphy, M. C., & Johnston, D. G. (1995) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1995.tb01860.x · Cited by 159
The expression of thyroid hormone receptors in human bone.
Abu, E. O., Bord, S., Horner, A., Chatterjee, V., & Compston, J. (1996) · Bone · doi:10.1016/s8756-3282(97)00097-5 · Cited by 159
Severity of vertebral fracture reflects deterioration of bone microarchitecture
Genant, H. K., Delmas, P. D., Chen, P., Jiang, Y., Eriksen, E. F., Dalsky, G. P., Marcus, R., & Martin, J. S. (2006) · Osteoporosis International · doi:10.1007/s00198-006-0199-6 · Cited by 158
Brenza, H. L., & DeLuca, H. F. (2000) · Archives of Biochemistry and Biophysics · doi:10.1006/abbi.2000.1970 · Cited by 157
Endogenous hormones and bone turnover markers in pre- and perimenopausal women: SWAN
Sowers, M. R., Greendale, G. A., Bondarenko, I., Finkelstein, J. S., Cauley, J. A., Neer, R. M., & Ettinger, B. B. (2003) · Osteoporosis International · doi:10.1007/s00198-002-1329-4 · Cited by 157
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Metadata
- Authors
- Mazziotti, G., Frara, S., & Giustina, A.
- Affiliations
- Azienda Ospedaliera Carlo Poma (IT)
- Vita-Salute San Raffaele University (IT)
- Corresponding author
- Giustina, Andrea
- Venue
- Endocrine Reviews
- Publisher
- The Endocrine Society
- Published
- 2018-04-19
- Volume
- 39
- Issue
- 4
- Pages
- 440-488
- ISSN
- 0163-769X (ISSN-L)
- 1945-7189
- OpenAlex
- W2802757031
- Semantic Scholar
- fc2486195e60c7a6d5657d25d8846333318c22bd
- Cited by
- 181
- References
- 648
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 31 · 2023: 20 · 2022: 21 · 2021: 26 · 2020: 23 · 2019: 18 · 2018: 6
- FWCI
- 17.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endocrine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Funders
- Pfizer
- Astellas Pharma
- Ipsen
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- pituitary disorders, bone, bone remodeling, bone metabolism, hypopituitarism, Cushing's disease, acromegaly, hyperprolactinemia, secondary osteoporosis, fracture risk, bone mineral density, bone quality
- MeSH terms
- Animals, Humans, Osteoporosis, Pituitary Diseases, Fractures, Bone
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.
A language model drew the claims from the paper on 2026-10-28, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (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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