The effects of cortisol and adrenal androgen on bone mass in Asians with and without subclinical hypercortisolism

  • S.H. Ahn
  • J. H. Kim
  • Y. Y. Cho
  • S. Suh
  • B.-J. Kim
  • S. Hong
  • S.H. Lee
  • J.-M. KohEmail author
  • K.-H. SongEmail author
Original Article



Analyses using the largest Korean cohort of adrenal incidentaloma (AI) revealed that subtle cortisol excess in premenopausal women and reduced dehydroepiandrosterone-sulfate (DHEA-S) in postmenopausal women and men are associated with bone mineral density (BMD) reduction in Asian patients with subclinical hypercortisolism (SH).


Few studies evaluated bone metabolism in Asians with SH. We investigated associations of cortisol and DHEA-S, an adrenal androgen, with BMD in Asians with AI, with or without SH.


We used cross-sectional data of a prospective multicenter study from Korea. We measured BMD, bone turnover markers, cortisol levels after 1-mg dexamethasone suppression test (1-mg DST), DHEA-S, and baseline cortisol to DHEA-S ratio (cort/DHEA-S) in 109 AI patients with SH (18 premenopausal, 38 postmenopausal women, and 53 men) and 686 with non-functional AI (NFAI; 59 premenopausal, 199 postmenopausal women, and 428 men).


Pre- and postmenopausal women, but not men, with SH had lower BMDs at lumbar spine (LS) than those with NFAI (P = 0.008~0.016). Premenopausal women with SH also had lower BMDs at the hip than those with NFAI (P = 0.009~0.012). After adjusting for confounders, cortisol levels after 1-mg DST demonstrated inverse associations with BMDs at all skeletal sites only in premenopausal women (β = − 0.042~− 0.033, P = 0.019~0.040). DHEA-S had positive associations with LS BMD in postmenopausal women (β = 0.096, P = 0.001) and men (β = 0.029, P = 0.038). The cort/DHEA-S had inverse associations with LS BMD in postmenopausal women (β = − 0.081, P = 0.004) and men (β = − 0.029, P = 0.011). These inverse associations of cort/DHEA-S remained significant after adjusting for cortisol levels after 1-mg DST (β = − 0.079~− 0.026, P = 0.006~0.029). In postmenopausal women, the odds ratios of lower BMD by DHEA-S and cort/DHEA-S was 0.26 (95% CI, 0.08–0.82) and 3.40 (95% CI, 1.12–10.33), respectively.


Subtle cortisol excess in premenopausal women and reduced DHEA-S in postmenopausal women and men may contribute to BMD reduction in Asians with SH.


Bone mineral density Bone turnover marker Cortisol Dehydroepiandrosterone-sulfate (DHEA-S) Subclinical hypercortisolism 


Funding information

This study was supported by grants from the National Research Foundation funded by the Korea government (Project No. NRF-2017R1C1B2009158), the Korea Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Project No. HI15C0377), the Asan Institute for Life Sciences, Seoul, Republic of Korea (Project no. 2016-347), and Dong-A ST (Seoul, Korea).

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflicts of interest


Supplementary material

198_2019_4871_MOESM1_ESM.pdf (119 kb)
ESM 1 (PDF 119 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Division of Endocrinology and Metabolism, Department of MedicineInha University Hospital, Inha University School of MedicineIncheonSouth Korea
  2. 2.Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  3. 3.Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University HospitalGyeongsang National University School of MedicineJinjuSouth Korea
  4. 4.Division of Endocrinology and Metabolism, Department of MedicineDong-A University Medical Center, Dong-A University College of MedicineBusanSouth Korea
  5. 5.Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  6. 6.Division of Endocrinology and Metabolism, Department of MedicineKonkuk University Medical Center, Konkuk University School of MedicineSeoulSouth Korea

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