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Subclinical hypercortisolism was associated with low BMD
Vertebral fractures were related to cortisol secretion degree.
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Researchers have discovered a high prevalence of vertebral fractures and low bone mineral density among eugonadal men with adrenal incidentalomas.
“The link between overt cortisol excess and bone fractures is well documented, but the relationship between subclinical hypercortisolism in patients with adrenal incidentalomas and bone fractures has not been extensively studied,” Iacopo Chiodini, MD, of the endocrine unit at the University of Milan in Italy, said in a press release.
According to Chiodini, this condition has been associated with reduced bone mass and increased vertebral fractures in women with adrenal incidentalomas.
“Men with adrenal incidentalomas and subclinical hypercortisolism have reduced bone mass and increased frequency of vertebral fractures,” he told Endocrine Today.
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The researchers evaluated eugonadal patients with adrenal incidentalomas with (n=22) or without (n=66) subclinical hypercortisolism.
Results showed z scores for lumbar spine BMD were 0.20 for the control group, 0.19 for the group without subclinical hypercortisolism and –1.04 for the group with subclinical hypercortisolism (P=.001).
For femoral neck BMD, the z scores were 0.26 for the control group, 0.01 for the group without subclinical hypercortisolism and –0.63 for the group with subclinical hypercortisolism (P=.002).
Osteoporosis was observed in 40.9% of patients with subclinical hypercortisolism vs. the group without subclinical hypercortisolism (18.2%) and the control group (16.7%), according to the researchers.
Vertebral fractures were observed in 20.0% of the control group compared with the group with subclinical hypercortisolism (72.7%) and the group without subclinical hypercortisolism (21.2%; P=.0001).
Subclinical hypercortisolism was associated with lumbar spine BMD (P=.0001) and vertebral fractures (OR=7.81; 95% CI, 1.96-31.17) in multivariable analyses, according to the study.
“In clinical practice, these findings may help to individuate patients at high risk for vertebral fractures and to address the treatment of choice (eg, surgery and/or medical treatment with bone-sparing agents),” he said.
Chiodini I. J Clin Endocrinol. 2009;70:208-213.