title: Fracture risk assessment before and after resolution of endogenous hypercortisolism: is the FRAX® algorithm useful?
abstract: OBJECTIVE
  Fracture risk data following curative treatment of Cushing's syndrome (CS) are scarce and the role of bisphosphonates in bone recovery after remission is controversial. We evaluated the effects of hypercortisolism remission in bone recovery in CS. Then, we assessed if the FRAX(®) algorithm calculated before the cure can predict fracture risk after cure.
  
  
  METHODS
  Thirty-six patients with CS were retrospectively investigated. Bone turnover markers, bone mineral density (BMD) at the lumbar spine (L1-L4) and left femur (both neck and total hip were considered), and fracture risk using FRAX(®) algorithm with femoral neck BMD were evaluated at diagnosis and after a median follow-up of 24 months (range 12-108 months) from hypercortisolism remission. Data about bone active therapy were analyzed.
  
  
  RESULTS
  Hypercortisolism remission was associated with the improvement of all densitometric parameters and with the reduction of fracture risk. The percentage change in BMD and the fracture risk were not significantly different in bisphosphonate-treated vs. untreated patients. During follow-up, three fractured patients at baseline exhibited a new vertebral fracture. A baseline 10-year probability of major osteoporotic fractures (FRAX(®) Major) of 17 % was able to predict the occurrence of a new vertebral fracture during follow-up after cure with 100 % sensitivity, 77 % specificity, 81 % positive predictive value and 100 % negative predictive value.
  
  
  CONCLUSIONS
  Osteoporosis and fracture risk may be reversible after curative treatment of CS, regardless of bisphosphonate therapy. We suggest applying the FRAX(®) algorithm to all active CS patients using a baseline FRAX(®) Major of 17 % as "intervention threshold".
authors.affiliation: Division of Endocrinology, Polytechnic University of Marche, Via Conca 71, Torrette di Ancona, 60020, Ancona, AN, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Trementino
authors.forename: Letizia
authors.initials: L
authors.lastname: Ceccoli
authors.forename: Carolina
authors.initials: C
authors.lastname: Concettoni
authors.forename: Giorgia
authors.initials: G
authors.lastname: Marcelli
authors.forename: Grazia
authors.initials: G
authors.lastname: Michetti
authors.forename: Marco
authors.initials: M
authors.lastname: Boscaro
authors.forename: Giorgio
authors.initials: G
authors.lastname: Arnaldi
mesh_terms: D000328:Adult; D000465:Algorithms; D003480:Cushing Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome