Subclinical hypercortisolism among outpatients referred for osteoporosis.
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.
Chiodini
Iacopo
I
San Giuseppe-Fatebenefratelli Hospital, Fatebenefratelli Research Association, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, Scientific Institute, Milan, Italy.
Mascia
Maria Lucia
ML
Muscarella
Silvana
S
Battista
Claudia
C
Minisola
Salvatore
S
Arosio
Maura
M
Santini
Stefano Angelo
SA
Guglielmi
Giuseppe
G
Carnevale
Vincenzo
V
Scillitani
Alfredo
A
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
D003907:Dexamethasone; D006854:Hydrocortisone