title: Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism.
abstract: Patients with adrenal incidentalomas (AIs) and subclinical hypercortisolism (SH) have increased risk of fracture independent of bone mineral density (BMD) and possibly due to reduced bone quality. The trabecular bone score (TBS) has been proposed as a index of bone microarchitecture. The aim of the study was to investigate TBS in AI. In 102 AI patients, SH was diagnosed in the presence of at least two of the following: (1) urinary free cortisol >70 µg/24 h (193.1 nmol/L); (2) cortisol after 1-mg dexamethasone suppression test (1-mg DST) >3.0 µg/dL (82.8 nmol/L); or (3) adrenocorticotropic hormone (ACTH) <10 pg/mL (<2.2 pmol/L). In patients and in 70 matched controls, BMD was measured at lumbar spine (LS) and femur (neck [FN] and total [FT]) by dual X-ray absorptiometry and TBS was assessed in the region of LS-BMD; BMD and TBS data were reported as Z-scores. In patients, vertebral deformities were assessed by radiograph. Patients with SH (n = 34) had lower LS-BMD (-0.31 ± 1.17), FT-BMD (-0.29 ± 0.91), and TBS (-3.18 ± 1.21) than patients without SH (n = 68, 0.31 ± 1.42, p = 0.03; 0.19 ± 0.97, p = 0.01; -1.70 ± 1.54, p < 0.0001, respectively) and controls (0.42 ± 1.52, p = 0.02; 0.14 ± 0.76, p = 0.02; -1.19 ± 0.99, p < 0.0001, respectively). TBS was inversely correlated with 1-mg DST (β = -0.26, t = -2.79, p = 0.006) regardless of age, LS-BMD, body mass index (BMI), and gender. The presence of fracture was associated with low TBS alone (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.85-12.42, p = 0.001) and with the cluster low TBS plus low LS-BMD (OR, 4.37; 95% CI, 1.71-11.4, p = 0.002), after adjustment for age, BMI, and gender. Low TBS plus low LS-BMD showed a good specificity (79%) for predicting fractures, whereas normal TBS (ie, > -1.5) plus normal LS-BMD high specificity (88.1%) for excluding fractures. Finally, TBS predicted the occurrence of a new fracture in 40 patients followed for 24 months (OR, 11.2; 95%CI, 1.71-71.41, p = 0.012) regardless of LS-BMD, BMI, and age. In SH, bone quality, as measured by TBS, is altered. TBS is useful in detecting AI patients at risk of fractures.
authors.affiliation: Unit of Endocrinology and Diabetology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda - Ospedale Maggiore Policlinico Department of Medical Sciences, University of Milan, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Ulivieri
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.forename: Volha V
authors.initials: VV
authors.lastname: Zhukouskaya
authors.forename: Elisa
authors.initials: E
authors.lastname: Cairoli
authors.forename: Rosa
authors.initials: R
authors.lastname: Pino
authors.forename: Antonella
authors.initials: A
authors.lastname: Naccarato
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000503:physiopathology*; D000308:Adrenocortical Hyperfunction / Q000150:complications* / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D001842:Bone and Bones / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications / Q000503:physiopathology; D013131:Spine / Q000002:abnormalities / Q000503:physiopathology
chemical_list: D006854:Hydrocortisone