title: High Evening Cortisol Level Is Associated With Low TBS and Increased Prevalent Vertebral Fractures: OsteoLaus Study.
abstract: Increased evening cortisol levels have been implicated in bone mineral density (BMD) loss. The effect on bone microarchitecture and fracture risk has never been studied.
  
  
  
  To study the relationship between salivary cortisol circadian rhythm and (1) trabecular bone score (TBS) and (2) fracture prevalence.
  
  
  
  Cross-sectional study including 608 women >50 years old (mean = 65.5) from the OsteoLaus cohort. Data included the FRAX© questionnaire, BMD, TBS and vertebral fracture (VFx) assessment by dual X-ray absorptiometry, and measures of salivary cortisol (awakening, 30 minutes thereafter, 11 am, and 8 pm).
  
  
  
  In the multivariate model, participants in the highest tertile of 8 pm salivary cortisol (sc-8 pm) (mean = 5.7 ± 2.5 nmol/L) vs lowest tertile (1.7 ± 0.4 nmol/L) had lower TBS values (1.27 vs 1.29; P = 0.02), more prevalent VFx grades 2 and 3 (odds ratio = 5.34; P = 0.012), low-trauma fractures (odds ratio = 1.80; P = 0.036), and major osteoporotic fractures (odds ratio = 1.96; P = 0.042), without difference in lumbar spine BMD (0.91 vs 0.92 g/cm2; P = 0.431). VFx prevalence was associated with sc-8 pm and TBS independently of each other and of other risk factors. The cut-point for sc-8 pm correlating with the presence of >1 VFx was 3.62 nmol/L (sensitivity 0.74, specificity 0.66).
  
  
  
  High sc-8 pm is associated with low TBS and an increased prevalence of radiologic VFx independently of other risk factors. Measurement of sc-8 pm may add relevant information in the assessment of fracture risk.
authors.affiliation: Center for Bone Diseases, Rheumatology Unit, Bone and Joint Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.|Endocrinology, Diabetology, and Metabolism Unit, Internal Medicine Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Elena
authors.initials: E
authors.lastname: Gonzalez Rodriguez
authors.affiliation: Center for Bone Diseases, Rheumatology Unit, Bone and Joint Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.|Internal Medicine Unit, Internal Medicine Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lamy
authors.affiliation: Center for Bone Diseases, Rheumatology Unit, Bone and Joint Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Delphine
authors.initials: D
authors.lastname: Stoll
authors.affiliation: Center for Bone Diseases, Rheumatology Unit, Bone and Joint Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Metzger
authors.affiliation: Epidemiology and Psychopathology Research Unit, Psychiatric Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Preisig
authors.affiliation: Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 58159 Mannheim, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Kuehner
authors.affiliation: Internal Medicine Unit, Internal Medicine Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Vollenweider
authors.affiliation: Internal Medicine Unit, Internal Medicine Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques-Vidal
authors.affiliation: Internal Medicine Unit, Internal Medicine Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Gérard
authors.initials: G
authors.lastname: Waeber
authors.affiliation: Center for Bone Diseases, Rheumatology Unit, Bone and Joint Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Bérengère
authors.initials: B
authors.lastname: Aubry-Rozier
authors.affiliation: Center for Bone Diseases, Rheumatology Unit, Bone and Joint Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Hans
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015519:Bone Density; D000071556:Cancellous Bone / Q000378:metabolism*; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism*; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D058866:Osteoporotic Fractures / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D018570:Risk Assessment; D012469:Salivary Glands / Q000378:metabolism; D016103:Spinal Fractures / Q000097:blood / Q000453:epidemiology*; D013557:Switzerland
chemical_list: D006854:Hydrocortisone