title: Increased risk of osteoporotic fractures in patients with Cushing's syndrome.
abstract: OBJECTIVE
  To evaluate if fracture risk was increased in patients with Cushing's syndrome due to the increased endogenous cortisol production.
  
  
  METHODS
  Cohort.
  
  
  METHODS
  A self-administered questionnaire was mailed to 125 patients with Cushing's syndrome diagnosed between 1985 and 1999 in Denmark. The response of each patient was compared with that of three age- and gender-matched control subjects randomly drawn among respondents to the same questionnaire from the background population.
  
  
  RESULTS
  One hundred and four patients (83%) responded. The median age of the patients was 48 years (range 19-85 years). Sixty-eight had pituitary disease, 28 had adrenal disease, four had had both pituitary and adrenal surgery while four had not undergone surgery at the time of the study. The median time from diagnosis to surgery was 0.2 (range 0-3) years. Eighty-six percent were cured following surgery. There was an increased fracture risk within the last 2 years prior to diagnosis (incidence rate ratio 6.0, 95% confidence intervals (CI): 2.1-17.2). More than 2 years prior to diagnosis and following diagnosis there was no difference in fracture risk between patients and controls. The patients had more low-energy fractures than the controls (relative risk 5.4, 95% CI: 1.4-20.1). There was no difference in fracture risk between patients with adrenal or pituitary disease.
  
  
  CONCLUSIONS
  Patients with Cushing's syndrome had an increased fracture risk in a narrow time interval before diagnosis, while no increase in fracture risk could be demonstrated after diagnosis and treatment.
authors.affiliation: The Osteoporosis Clinic, Department of Endocrinology and Metabolism, Aarhus Amtssygehus, Tage Hansens Gade 2, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. p-vest@post4.tele.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
authors.forename: Jørgen
authors.initials: J
authors.lastname: Lindholm
authors.forename: Jens Otto L
authors.initials: JO
authors.lastname: Jørgensen
authors.forename: Claus
authors.initials: C
authors.lastname: Hagen
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Hoeck
authors.forename: Peter
authors.initials: P
authors.lastname: Laurberg
authors.forename: Lars
authors.initials: L
authors.lastname: Rejnmark
authors.forename: Kim
authors.initials: K
authors.lastname: Brixen
authors.forename: Lars Ø
authors.initials: LØ
authors.lastname: Kristensen
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.forename: Leif
authors.initials: L
authors.lastname: Mosekilde
mesh_terms: D000311:Adrenal Glands / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003480:Cushing Syndrome / Q000150:complications*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology*; D010902:Pituitary Gland / Q000503:physiopathology; D016012:Poisson Distribution; D012307:Risk Factors; D011795:Surveys and Questionnaires