title: Subclinical hypercortisolism among outpatients referred for osteoporosis.
abstract: BACKGROUND
  Hypercortisolism is known to cause osteoporosis.
  
  
  OBJECTIVE
  To evaluate the prevalence of subclinical hypercortisolism in participants referred for evaluation of osteoporosis.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Two community hospitals and research institutes in Italy.
  
  
  METHODS
  219 patients without clinically overt hypercortisolism or other secondary causes of osteoporosis who were referred for evaluation of osteoporosis between January 2005 and December 2005.
  
  
  METHODS
  Bone mineral density was measured by using dual-energy x-ray absorptiometry, and hypercortisolism was assessed with serum cortisol levels after a dexamethasone suppression test. Also measured were 24-hour urinary free cortisol levels and midnight plasma cortisol levels.
  
  
  RESULTS
  Seven of 65 patients with T-scores of 2.5 or less and vertebral fractures had subclinical hypercortisolism (prevalence, 10.8% [95% CI, 3.23% to 18.31%]). This prevalence was 4.8% (CI, 1.32% to 8.20%) among patients with osteoporosis. In multivariable analyses adjusted for age, sex, and body mass index, a positive dexamethasone suppression test result was associated with the presence of osteoporosis (odds ratio, 3.37 [CI, 1.78 to 6.43]; P < 0.001) and vertebral fractures (odds ratio, 1.70 [CI, 1.04 to 2.79]; P = 0.035).
  
  
  CONCLUSIONS
  The study was conducted in a referral setting; its findings may not apply to the general population.
  
  
  CONCLUSIONS
  Subclinical hypercortisolism may be more common than is generally recognized in patients with osteoporosis in whom secondary causes of osteoporosis have been excluded.
authors.affiliation: San Giuseppe-Fatebenefratelli Hospital, Fatebenefratelli Research Association, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, Scientific Institute, Milan, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Mascia
authors.forename: Silvana
authors.initials: S
authors.lastname: Muscarella
authors.forename: Claudia
authors.initials: C
authors.lastname: Battista
authors.forename: Salvatore
authors.initials: S
authors.lastname: Minisola
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.forename: Stefano Angelo
authors.initials: SA
authors.lastname: Santini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Carnevale
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
mesh_terms: D000308:Adrenocortical Hyperfunction / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D000368:Aged; D015519:Bone Density; D003430:Cross-Sectional Studies; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications* / Q000209:etiology; D010912:Pituitary-Adrenal Function Tests; D015995:Prevalence; D012307:Risk Factors; D016103:Spinal Fractures / Q000209:etiology
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone