Bone mineral density, prevalence of vertebral fractures, and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: an Italian multicenter study.
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.
Chiodini
Iacopo
I
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
Morelli
Valentina
V
Masserini
Benedetta
B
Salcuni
Antonio Stefano
AS
Eller-Vainicher
Cristina
C
Viti
Raffaella
R
Coletti
Francesca
F
Guglielmi
Giuseppe
G
Battista
Claudia
C
Carnevale
Vincenzo
V
Iorio
Laura
L
Beck-Peccoz
Paolo
P
Arosio
Maura
M
Ambrosi
Bruno
B
Scillitani
Alfredo
A
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*