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Primary aldosteronism may be cause behind secondary osteoporosis
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Patients with secondary osteoporosis are 10 times more likely to have primary aldosteronism than patients without osteoporosis, according to findings from an Italian study.
In an analysis of patient data, researchers also found that about one-quarter of patients with osteoporosis, hypertension and hypercalciuria are also affected with primary aldosteronism, suggesting the condition could be an underlying cause of unexplained osteoporosis.
“Recent data showed that a condition of an otherwise asymptomatic cortisol excess (ie, subclinical hypercortisolism) is more prevalent than expected in patients with osteoporosis,” Antonio Stefano Salcuni, of Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy, and colleagues wrote. “Given the negative role of the aldosterone excess on bone tissue, we hypothesized that in patients with osteoporosis there was a high prevalence of [primary aldosteronism].”
Salcuni and colleagues analyzed data from 322 adults referred to Casa Sollievo della Sofferenza Hospital for metabolic bone disease between November 2012 and May 2015. Included patients did not have diseases known to affect bone metabolism apart from hypercalciuria; patients with hypertension were recruited after their antihypertensive medications were discontinued. All participants underwent DXA measurements to assess bone mineral density at the lumbar spine, total hip and femoral neck and thoracic and lumbar spine radiograph for vertebral fracture assessment. Researchers measured serum calcium, albumin phosphorus, creatinine, 24-hour urinary calcium and creatinine excretion, serum intact parathyroid hormone and serum 25-hydroxyvitamin D, as well as plasma aldosterone concentration, plasma renin activity level and aldosterone to renin ratio. Researchers used logistic regression analysis to assess the association between the presence of osteoporosis or fractures as independent variables and age, BMI, presence of primary aldosteronism, essential hypertension and spinal BMD (for patients with fracture only).
Within the cohort, 115 had hypertension.
Researchers observed that the overall prevalence of primary aldosteronism was 3.7%. The rate increased to 5.2% in patients with osteoporosis (11 of 213), 6.9% in patients with fracture (five of 72), 9.1% in patients with hypercalciuria (seven of 77) and 9.6% in patients with hypertension (11 of 115). The prevalence rate of primary aldosteronism further increased in patients with osteoporosis and hypertension (13.9%), fracture and hypertension (14.8%), fracture and hypercalciuria (11.1%), and osteoporosis, hypertension and hypercalciuria (26.1%).
Researchers observed a weak, but direct association between serum aldosterone and daily urinary calcium excretion (r = 0.123; P = .028) and urinary calcium to weight ratio (r = 0.124; P = .027), as well as an association between serum aldosterone and parathyroid hormone (r = 0.16; P = .005).
In logistic regression analysis, researchers observed that osteoporosis was associated with primary aldosteronism (OR = 10.42; 95% CI, 1.21-90.91), as well as age (OR = 1.06; 95% CI, 1.03-1.09) and BMI (OR = 1.11; 95% CI, 1.05-1.17), but not with the presence of essential hypertension (OR = 1.23; 95% CI, 0.72-2.1).
The study findings “suggest [primary aldosteronism] is a cause of osteoporosis and should be searched for in patients with an unexplained form of osteoporosis, particularly in hypertensive subjects with hypercalciuria,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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