Bone density and microarchitecture in endogenous hypercortisolism.
OBJECTIVE
Osteoporosis is a serious and underestimated complication of endogenous hypercortisolism that results in an increased risk of fractures, even in patients with normal or slightly decreased bone mineral density (BMD). Alterations in bone microarchitecture, a very important component of bone quality, may explain bone fragility. The aim of this study was to investigate bone density and microarchitecture in a cohort of patients with endogenous Cushing's syndrome (CS).


METHODS
Cross-sectional study.


METHODS
Thirty patients with endogenous active CS and fifty-one age-, sex- and body mass index-matched controls were included.


METHODS
Participants were studied for areal BMD (dual-energy X-ray absorptiometry) of the lumbar spine (LS), femoral neck (FN), total femur (TF) and radius (33%), and for volumetric bone density (vBMD) and structure using high-resolution peripheral quantitative computed tomography (HR-pQCT) of the distal radius and distal tibia.


RESULTS
Patients with active CS exhibited lower areal BMD and Z-score values in the LS, FN and TF (P < 0·003 for all comparisons). At HR-pQCT, the patients with CS also had lower cortical area (P = 0·009 at the radius and P = 0·002 at the tibia), lower cortical thickness (P = 0·02 at the radius and P = 0·002 at the tibia), lower cortical density (P = 0·008 at the tibia) and lower total vBMD (P = 0·002 at the tibia). After the exclusion of hypogonadal individuals, the patients with CS maintained the same microarchitectural and densitometric alterations described above.


CONCLUSIONS
Endogenous hypercortisolism has deleterious effects on bone, especially on cortical bone microstructure. These effects seem to be a more important determinant of bone impairment than gonadal status.
Division of Endocrinology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.
Camila V
CV
dos Santos
Division of Endocrinology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.|Division of Endocrinology of Lagoa Federal Hospital, Rio de Janeiro, Brazil.
Leonardo
L
Vieira Neto
Division of Endocrinology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.|Division of Endocrinology of Bonsucesso Federal Hospital, Rio de Janeiro, Brazil.
Miguel
http://orcid.org/0000-0001-6752-2880
M
Madeira
Division of Endocrinology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.
Maria Caroline
MC
Alves Coelho
Division of Rheumatology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.
Laura Maria Carvalho
LM
de Mendonça
Division of Endocrinology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.
Francisco de Paula
Fde P
Paranhos-Neto
Nuclear Instrumentation Laboratory, COPPE-PEN, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Inayá Corrêa Barbosa
IC
Lima
Division of Endocrinology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.
Mônica R
MR
Gadelha
Division of Endocrinology, Department of Internal Medicine, Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Brazil.
Maria Lucia Fleiuss
ML
Farias
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology*; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000150:complications / Q000378:metabolism*; D005260:Female; D005272:Femur Neck / Q000378:metabolism / Q000473:pathology; D050723:Fractures, Bone / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000378:metabolism; D011884:Radius / Q000378:metabolism / Q000473:pathology; D055815:Young Adult