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Assessment of non-traumatic vertebral fractures in Cushing’s syndrome patients

Journal of Endocrinological Investigation volume 44, pages 1767–1773 (2021)Cite this article

Abstract

Purpose

Hypercortisolism has detrimental effects on bone metabolism with the consequences of bone loss and bone fractures. We aimed to evaluate the frequency of vertebral fragility fractures and to determine the factors associated with Cushing’s syndrome (CS).

Methods

A total of 135 patients diagnosed with Cushing’s syndrome [108 patients with Cushing’s disease and 27 patients with adrenocortical adenoma] and 107 healthy controls were included in this cross-sectional study. The available clinical, laboratory, and radiologic data of patients with CS were recorded, retrospectively. Lateral vertebral radiograms were evaluated for vertebral fragility fractures according to Genant’s semi-quantitative method. Bone mineral density (BMD) was determined using a Dual-energy X-ray absorptiometry (DEXA).

Results

Vertebral fragility fractures (VFs) were observed in 75.3% (n = 61) of the patients. The median number of VFs was six (min–max: 2–12). All patients with vertebral fractures had thoracic VF, and 50.7% of the patients had lumbar fragility fractures. Thirty-three (40.7%) patients with vertebral fractures had normal bone densitometry values. Osteoporosis and osteopenia were observed in 16.2% and 40.7% of the patients, respectively. The duration of active disease, the presence of ACTH-secreting pituitary adenoma, and 24-h urinary cortisol did not influence the presence of vertebral fractures. Vertebral fractures were independently associated with age, FSH, LH levels, and lumbar BMD (R2 = 68.18%, p = 0.028). The femoral neck BMD (but not lumbar BMD) was independently associated with age, BMI, and PTH levels (R2 = 48.48%, p < 0.001).

Conclusion

Vertebral fracture frequency was higher in CS patients. Most of the patients with vertebral fractures had multiple fractures. Although low lumbar BMD was associated with VF, patients with CS with normal bone densitometry could experience VF. Vertebral radiograph evaluations as a part of routine evaluation for silent vertebral fractures may help to prevent further fractures in patients with CS.

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Acknowledgements

This study did not receive any specific grants from any funding agencies in the public, commercial, or nonprofit sector.

Funding

This study did not receive any specific grants from any funding agencies in the public, commercial, or not-for-profit sector.

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  1. Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey

    T. Apaydın & D. G. Yavuz

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  1. T. Apaydın
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Contributions

All authors made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data, participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be submitted.

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Correspondence to T. Apaydın.

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Tugce Apaydin and Dilek Gogas Yavuz declare that they have no conflict of interest.

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

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Apaydın, T., Yavuz, D.G. Assessment of non-traumatic vertebral fractures in Cushing’s syndrome patients. J Endocrinol Invest 44, 1767–1773 (2021). https://doi.org/10.1007/s40618-020-01496-y

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  • DOI: https://doi.org/10.1007/s40618-020-01496-y

Keywords

  • Cushing syndrome
  • Bone loss
  • Pathologic fractures
  • Osteoporosis