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Fracture risk assessment before and after resolution of endogenous hypercortisolism: Is the FRAX® algorithm useful?

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Abstract

Purpose

Fracture risk data following curative treatment of Cushing’s syndrome (CS) are scarce and the role of bisphosphonates in bone recovery after remission is controversial. We evaluated the effects of hypercortisolism remission in bone recovery in CS. Then, we assessed if the FRAX® algorithm calculated before the cure can predict fracture risk after cure.

Methods

Thirty-six patients with CS were retrospectively investigated. Bone turnover markers, bone mineral density (BMD) at the lumbar spine (L1–L4) and left femur (both neck and total hip were considered), and fracture risk using FRAX® algorithm with femoral neck BMD were evaluated at diagnosis and after a median follow-up of 24 months (range 12–108 months) from hypercortisolism remission. Data about bone active therapy were analyzed.

Results

Hypercortisolism remission was associated with the improvement of all densitometric parameters and with the reduction of fracture risk. The percentage change in BMD and the fracture risk were not significantly different in bisphosphonate-treated vs. untreated patients. During follow-up, three fractured patients at baseline exhibited a new vertebral fracture. A baseline 10-year probability of major osteoporotic fractures (FRAX® Major) of 17 % was able to predict the occurrence of a new vertebral fracture during follow-up after cure with 100 % sensitivity, 77 % specificity, 81 % positive predictive value and 100 % negative predictive value.

Conclusions

Osteoporosis and fracture risk may be reversible after curative treatment of CS, regardless of bisphosphonate therapy. We suggest applying the FRAX® algorithm to all active CS patients using a baseline FRAX® Major of 17 % as “intervention threshold”.

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Acknowledgments

The authors would like to thank Mihaela Voinea, PhD, of Excerpta Medica, who provided editorial assistance and styling prior to submission. This research was partially supported by PRIN (grant number 201098WFZ2_006).

Conflict of interest

The Authors have no conflict of interest to declare. The authors received editorial/writing support in the preparation of this manuscript provided by Excerpta Medica, funded by Novartis Oncology Region Europe. The authors did not receive honoraria related to the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Endocrinology, Polytechnic University of Marche, Via Conca 71, Torrette di Ancona, 60020, Ancona, AN, Italy

    Laura Trementino, Letizia Ceccoli, Carolina Concettoni, Giorgia Marcelli, Grazia Michetti, Marco Boscaro & Giorgio Arnaldi

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  1. Laura Trementino
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  2. Letizia Ceccoli
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  3. Carolina Concettoni
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  4. Giorgia Marcelli
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  5. Grazia Michetti
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  6. Marco Boscaro
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  7. Giorgio Arnaldi
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Corresponding author

Correspondence to Giorgio Arnaldi.

Additional information

L. Trementino and L. Ceccoli contributed equally to this work.

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Trementino, L., Ceccoli, L., Concettoni, C. et al. Fracture risk assessment before and after resolution of endogenous hypercortisolism: Is the FRAX® algorithm useful?. J Endocrinol Invest 37, 957–965 (2014). https://doi.org/10.1007/s40618-014-0126-1

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  • DOI: https://doi.org/10.1007/s40618-014-0126-1

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