Fragility fractures in well‐differentiated gastroenteropancreatic neuroendocrine tumors: Results from a multicentered retrospective study

• Published in: Journal of neuroendocrinology p. e70053
• Main Authors: Brunetti, Alessandro, Cellini, Miriam, Lavezzi, Elisabetta, Zerbi, Alessandro, Ferrillo, Giuseppe, Birtolo, Maria Francesca, Berruti, Alfredo, Cavati, Guido, Lagana, Marta, Gennari, Luigi, Girometti, Rossano, Zuiani, Chiara, Grimaldi, Franco, Lania, Andrea G., Vescini, Fabio, Mazziotti, Gherardo
• Format: Journal Article
• Language: English
• Published: United States 01.06.2025
• Subjects: parathyroid hormone; osteoporosis; vitamin D; fractures; neuroendocrine tumors
• ISSN: 0953-8194; 1365-2826; 1365-2826
• DOI: 10.1111/jne.70053

Patients with gastroenteropancreatic–neuroendocrine tumors (GEP‐NETs) may present skeletal fragility that might be related to multiple factors, including bone metastases, vitamin D deficiency, hormone secretion, and disease treatments. This study examines the prevalence and determinants of fragility fractures in low grading (G1‐G2) GEP‐NETs. This retrospective study included 291 patients with G1‐G2 GEP‐NETs (154 men and 137 women). A longitudinal examination was available for 247 patients, with a median follow‐up of 49 months (range 24–83). Information regarding disease course, osteo‐metabolic profile, and clinical fractures were collected from electronic medical records. Opportunistic chest‐abdomen computed tomography or magnetic resonance imaging scans were retrospectively examined to investigate morphometric vertebral fractures. Fracture prevalence in men over 50 and post‐menopausal women ( n = 200) was compared to an age‐matched control sample of 1010 subjects (146 men and 864 women). Forty‐five patients with GEP‐NETs (15.5%) had fragility fractures at diagnosis of disease. Fractures were significantly associated with age, body mass index, comorbidities, and severe vitamin D deficiency (25(OH)vitamin D < 10 ng/mL) at univariate analysis, and to severe vitamin D deficiency ( p = .03) and age ( p = .01) at multivariate analysis. When compared to the control group, GEP‐NETs patients were found to be independently associated with fractures (OR 2.0 IC95% [1.1–3.6], p = .02). At longitudinal evaluation, 10% of GEP‐NETs experienced new fractures in relation to pre‐existing fractures and surgical treatment of the tumor. This study provides first evidence that GEP‐NETs may have a high risk of fragility fractures at the diagnosis of the disease. A proper and early assessment of bone health is therefore advisable in these patients.