Body composition and bone mineral density in craniopharyngioma patients: A longitudinal study over 10 years

Context: Patients with craniopharyngioma suffer from obesity and impaired bone health. Little is known about longitudinal changes in body composition and bone mineral density (BMD). Objective: To describe body composition and BMD (change). Design: Retrospective longitudinal study. Setting: Two Dutch/Swedish referral centers. Patients: Patients with craniopharyngioma (n = 112) with a dual X-ray absorptiometry (DXA) scan available (2 DXA scans, n = 86; median Δtime 10.0 years; range 0.4-23.3) at age ≥ 18 years (58 [52%] male, 50 [45%] childhood onset). Main outcome measures: Longitudinal changes of body composition and BMD, and associated factors of ΔZ-score (sex and age standardized). Results: BMI (from 28.8 ± 4.9 to 31.2 ± 5.1 kg/m², P < .001), fat mass index (FMI) (from 10.5 ± 3.6 to 11.9 ± 3.8 kg/m², P = .001), and fat free mass index (FFMI) (from 18.3 ± 3.2 to 19.1 ± 3.2 kg/m², P < .001) were high at baseline and increased. Fat percentage and Z-scores of body composition did not increase, except for FFMI Z-scores (from 0.26 ± 1.62 to 1.06 ± 2.22, P < .001). Z-scores of total body, L2-L4, femur neck increased (mean difference 0.61 ± 1.12, P < .001; 0.74 ± 1.73, P < .001; 0.51 ± 1.85, P = .02). Linear regression models for ΔZ-score were positively associated with growth hormone replacement therapy (GHRT) (femur neck: beta 1.45 [95% CI 0.51–2.39]); and negatively with radiotherapy (femur neck: beta –0.79 [–1.49 to –0.09]), glucocorticoid dose (total body: beta –0.06 [–0.09 to –0.02]), and medication to improve BMD (L2-L4: beta –1.06 [–1.84 to –0.28]). Conclusions: Z-scoresofBMI,fatpercentage,andFMIremainedstableinpatientswithcraniopharyngioma over time, while Z-scores of FFMI and BMD increased. Higher glucocorticoid dose and radiotherapy were associated with BMD loss and GHRT with increase.