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Bone quality in endocrine diseases: determinants and clinical relevance

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Abstract

Purpose

Bone is one of the main targets of hormones and endocrine diseases are frequent causes of secondary osteoporosis and fractures in real-world clinical practice. However, diagnosis of skeletal fragility and prediction of fractures in this setting could be a challenge, since the skeletal alterations induced by endocrine disorders are not generally captured by dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD), that is the gold standard for diagnosis of osteoporosis in the general population. The aim of this paper is to review the existing evidence related to bone quality features in endocrine diseases, proposing assessment with new techniques in the future.

Methods

A comprehensive search within electronic databases was performed to collect reports of bone quality in primary hyperparathyroidism, hypoparathyroidism, hyperthyroidism, hypercortisolism, growth hormone deficiency, acromegaly, male hypogonadism and diabetes mellitus.

Results

Using invasive and non-invasive techniques, such as high-resolution peripheral quantitative computed tomography or DXA measurement of trabecular bone score (TBS), several studies consistently reported altered bone quality as predominant determinant of fragility fractures in subjects affected by chronic endocrine disorders.

Conclusions

Assessment of skeletal fragility in endocrine diseases might take advantage from the use of techniques to detect perturbation in bone architecture with the aim of best identifying patients at high risk of fractures.

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Authors and Affiliations

  1. Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy

    L. Cianferotti

  2. Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    C. Cipriani

  3. Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy

    S. Corbetta

  4. Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    S. Corbetta

  5. Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy

    G. Corona

  6. Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128, Rome, Italy

    G. Defeudis & N. Napoli

  7. Department of Movement, Human and Health Sciences, Health Sciences Section, University “Foro Italico”, Rome, Italy

    G. Defeudis

  8. Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy

    A. G. Lania & G. Mazziotti

  9. Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Via A Manzoni 56, 20089, Rozzano, MI, Italy

    A. G. Lania & G. Mazziotti

  10. Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    C. Messina

  11. Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA

    N. Napoli

  12. University of Milan, Department of Biomedical Sciences for Health, Milan, Italy

    C. Messina

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Cianferotti, L., Cipriani, C., Corbetta, S. et al. Bone quality in endocrine diseases: determinants and clinical relevance. J Endocrinol Invest 46, 1283–1304 (2023). https://doi.org/10.1007/s40618-023-02056-w

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