title: Bone mineral density, prevalence of vertebral fractures, and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian multicenter study.
abstract: BACKGROUND
  In patients with adrenal incidentalomas and subclinical hypercortisolism (SH), the factors influencing bone and the prevalence of vertebral fractures are debated. Spinal deformity index (SDI), which reflects bone quality, has never been evaluated.
  
  
  OBJECTIVE
  The objective of the study was to investigate in these patients SDI and factors influencing the prevalence of fractures.
  
  
  METHODS
  This was a retrospective, multicenter study.
  
  
  METHODS
  The study was conducted on an in- and outpatient basis.
  
  
  METHODS
  Patients included 287 adrenal incidentaloma patients (111 eugonadal males, 31 premenopausal, 145 postmenopausal females) and 194 controls (90 eugonadal males, 29 premenopausal, 75 postmenopausal females).
  
  
  METHODS
  Bone mineral density (BMD) was measured by dual X-ray absorptiometry at lumbar spine and femoral neck. By radiograph each vertebra was assessed as intact (grade 0) or grade 1 (20-25%), 2 (25-40%), or 3 (>40%) deformity; SDI was calculated by summing the grade of deformity for each vertebra. SH was diagnosed in the presence of at least two of the following: urinary free cortisol greater than 70 microg per 24 h (193.1 nmol/liter), cortisol after 1-mg dexamethasone test greater than 3.0 microg/dl (>82.8 nmol/liter), ACTH less than 10 pg/ml (<2.2 pmol/liter).
  
  
  RESULTS
  BMD was significantly lower in SH+ than SH- patients and controls (lumbar spine -0.73 +/- 1.43, 0.17 +/- 1.33, 0.12 +/- 1.21, respectively; femoral neck -0.37 +/- 1.06, 0.07 +/- 1.09, 0.17 +/- 1.02). Patients with SH had higher fracture prevalence and SDI than those without SH and controls (70.6, 22.2, 21.8%, respectively, P < 0.0001; 0.31 +/- 0.68, 0.39 +/- 0.93, 1.35 +/- 1.27, respectively, P < 0.0001). Fractures and SDI were associated with SH (odds ratio 7.27, 95% confidence interval 3.94-13.41, P = 0.0001; beta = 0.352, t = 6.241, P = 0.0001, respectively) regardless of age, BMD, menopause, and gender.
  
  
  CONCLUSIONS
  SH is associated with low BMD, high fracture prevalence, and reduced bone quality as measured by SDI.
authors: Unit of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico, Mangiagalli e Regina Elena, Instituto di Ricovero e Cura a Carattere Scientifico, 20122 Milan, Italy. iacopo.chiodini@e-mail.it
authors: Iacopo
authors: I
authors: Chiodini
authors: Valentina
authors: V
authors: Morelli
authors: Benedetta
authors: B
authors: Masserini
authors: Antonio Stefano
authors: AS
authors: Salcuni
authors: Cristina
authors: C
authors: Eller-Vainicher
authors: Raffaella
authors: R
authors: Viti
authors: Francesca
authors: F
authors: Coletti
authors: Giuseppe
authors: G
authors: Guglielmi
authors: Claudia
authors: C
authors: Battista
authors: Vincenzo
authors: V
authors: Carnevale
authors: Laura
authors: L
authors: Iorio
authors: Paolo
authors: P
authors: Beck-Peccoz
authors: Maura
authors: M
authors: Arosio
authors: Bruno
authors: B
authors: Ambrosi
authors: Alfredo
authors: A
authors: Scillitani
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density; D003480:Cushing Syndrome / Q000150:complications* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000453:epidemiology*