Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing's Syndrome

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2021 Feb 15

PMID 33584537

Citations 7

Authors

Barbara Stachowska

Jowita Halupczok-Zyla

Justyna Kuliczkowska-Plaksej

Joanna Syrycka

Marek Bolanowski

Affiliations

Soon will be listed here.

Abstract

Introduction: The impairment in bone microarchitecture and reduced bone quality are relevant mechanisms underlying the increased fracture risk in Cushing's syndrome (CS). The trabecular bone score (TBS) is a relatively novel textural index of bone microarchitecture.

Purpose: The objective of the study was to compare TBS, bone mineral density (BMD), and fracture risk in patients with endogenous CS to controls. We have investigated the association of TBS with anthropometric parameters and 25(OH) vitamin D concentrations.

Materials And Methods: The study group comprised 19 consecutive patients with CS (14 women and 5 men; mean age 45.84 ± 13.15 years) and sex-, age-matched 36 controls (25 women and men; mean age 52.47 ± 8.98 years). Anthropometric parameters, biochemical and hormonal data were compared between groups. Lumbar spine (L1-L4) and femoral neck BMD (LS BMD, FN BMD) measurements were performed. TBS values were obtained from lumbar spine DXA images.

Results: TBS was significantly lower in patients with CS compared to controls (p = 0.0002). The 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture were significantly higher in the CS group than in controls (p = 0.03, p < 0.0001, respectively). All subjects from the CS group with fractures had low TBS value (degraded microarchitecture). TBS correlated negatively with the duration of disease in patients with CS (r = -0.590 p = 0.008).

Conclusions: The patients with active CS have altered bone microstructure as indicated by the decreased TBS and are at higher risk of hip and a major osteoporotic fractures. TBS seems to be a very important analytical tool facilitating fracture risk assessment in endogenous hypercortisolism.

Citing Articles

Relationship Among Fragility Fractures and the Overall Cardiovascular Burden in Endogenous Cushing Syndrome.

Voltan G, Mazzeo P, Cannito M, Pinelli S, Barbot M, Scaroni C J Endocr Soc. 2025; 9(3):bvaf008.

PMID: 39935696 PMC: 11811415. DOI: 10.1210/jendso/bvaf008.

[Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024) : Guidelines of the Austrian Society for Bone and Mineral Research].

Dimai H, Muschitz C, Amrein K, Bauer R, Cejka D, Gasser R Wien Klin Wochenschr. 2024; 136(Suppl 16):599-668.

PMID: 39356323 PMC: 11447007. DOI: 10.1007/s00508-024-02441-2.

Skeletal fragility in pituitary disease: how can we predict fracture risk?.

Bioletto F, Berton A, Barale M, Aversa L, Sauro L, Presti M Pituitary. 2024; 27(6):789-801.

PMID: 39240510 PMC: 11631825. DOI: 10.1007/s11102-024-01447-3.

Cushing's disease and bone.

Zdrojowy-Welna A, Stachowska B, Bolanowski M Pituitary. 2024; 27(6):837-846.

PMID: 39008229 PMC: 11631814. DOI: 10.1007/s11102-024-01427-7.

Diagnosis and therapeutic approach to bone health in patients with hypopituitarism.

Kuliczkowska-Plaksej J, Zdrojowy-Welna A, Jawiarczyk-Przybylowska A, Gojny L, Bolanowski M Rev Endocr Metab Disord. 2024; 25(3):513-539.

PMID: 38565758 DOI: 10.1007/s11154-024-09878-w.

References

Valassi E, Franz H, Brue T, Feelders R, Netea-Maier R, Tsagarakis S . Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN. Eur J Endocrinol. 2017; 176(5):613-624. DOI: 10.1530/EJE-16-0967. View

Genant H, Wu C, van Kuijk C, Nevitt M . Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993; 8(9):1137-48. DOI: 10.1002/jbmr.5650080915. View

Langsetmo L, Vo T, Ensrud K, Taylor B, Cawthon P, Schwartz A . The Association Between Trabecular Bone Score and Lumbar Spine Volumetric BMD Is Attenuated Among Older Men With High Body Mass Index. J Bone Miner Res. 2016; 31(10):1820-1826. PMC: 5253074. DOI: 10.1002/jbmr.2867. View

Toth M, Grossman A . Glucocorticoid-induced osteoporosis: lessons from Cushing's syndrome. Clin Endocrinol (Oxf). 2013; 79(1):1-11. DOI: 10.1111/cen.12189. View

Chiodini I, Eller Vainicher C, Morelli V, Palmieri S, Cairoli E, Salcuni A . MECHANISMS IN ENDOCRINOLOGY: Endogenous subclinical hypercortisolism and bone: a clinical review. Eur J Endocrinol. 2016; 175(6):R265-R282. DOI: 10.1530/EJE-16-0289. View

Bazzocchi A, Ponti F, Diano D, Amadori M, Albisinni U, Battista G . Trabecular bone score in healthy ageing. Br J Radiol. 2015; 88(1052):20140865. PMC: 4651387. DOI: 10.1259/bjr.20140865. View

Saag K, Agnusdei D, Hans D, Kohlmeier L, Krohn K, Leib E . Trabecular Bone Score in Patients With Chronic Glucocorticoid Therapy-Induced Osteoporosis Treated With Alendronate or Teriparatide. Arthritis Rheumatol. 2016; 68(9):2122-8. DOI: 10.1002/art.39726. View

Rahaman S, Jyotsna V, Kandasamy D, Shreenivas V, Gupta N, Tandon N . Bone Health in Patients with Cushing's Syndrome. Indian J Endocrinol Metab. 2019; 22(6):766-769. PMC: 6330848. DOI: 10.4103/ijem.IJEM_160_18. View

Hirsch D, Shimon I, Manisterski Y, Aviran-Barak N, Amitai O, Nadler V . Cushing's syndrome: comparison between Cushing's disease and adrenal Cushing's. Endocrine. 2018; 62(3):712-720. DOI: 10.1007/s12020-018-1709-y. View

10.

Compston J . Clinical question: What is the best approach to managing glucocorticoid-induced osteoporosis?. Clin Endocrinol (Oxf). 2011; 74(5):547-50. DOI: 10.1111/j.1365-2265.2011.03994.x. View

11.

Leib E, Winzenrieth R . Bone status in glucocorticoid-treated men and women. Osteoporos Int. 2015; 27(1):39-48. DOI: 10.1007/s00198-015-3211-1. View

12.

Trementino L, Ceccoli L, Concettoni C, Marcelli G, Michetti G, Boscaro M . Fracture risk assessment before and after resolution of endogenous hypercortisolism: is the FRAX® algorithm useful?. J Endocrinol Invest. 2014; 37(10):957-65. DOI: 10.1007/s40618-014-0126-1. View

13.

Dalle Carbonare L, Arlot M, Chavassieux P, Roux J, Portero N, Meunier P . Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res. 2001; 16(1):97-103. DOI: 10.1359/jbmr.2001.16.1.97. View

14.

Evans A, Paggiosi M, Eastell R, Walsh J . Bone density, microstructure and strength in obese and normal weight men and women in younger and older adulthood. J Bone Miner Res. 2014; 30(5):920-8. DOI: 10.1002/jbmr.2407. View

15.

Dufour R, Winzenrieth R, Heraud A, Hans D, Mehsen N . Generation and validation of a normative, age-specific reference curve for lumbar spine trabecular bone score (TBS) in French women. Osteoporos Int. 2013; 24(11):2837-46. DOI: 10.1007/s00198-013-2384-8. View

16.

Nuti R, Brandi M, Checchia G, Di Munno O, Dominguez L, Falaschi P . Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med. 2018; 14(1):85-102. PMC: 6329834. DOI: 10.1007/s11739-018-1874-2. View

17.

Simonelli C, Leib E, Mossman N, Winzenrieth R, Hans D, McClung M . Creation of an age-adjusted, dual-energy x-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in non-Hispanic US White women. J Clin Densitom. 2014; 17(2):314-9. DOI: 10.1016/j.jocd.2013.09.002. View

18.

Valassi E, Santos A, Yaneva M, Toth M, Strasburger C, Chanson P . The European Registry on Cushing's syndrome: 2-year experience. Baseline demographic and clinical characteristics. Eur J Endocrinol. 2011; 165(3):383-92. DOI: 10.1530/EJE-11-0272. View

19.

Pecori Giraldi F, Moro M, Cavagnini F . Gender-related differences in the presentation and course of Cushing's disease. J Clin Endocrinol Metab. 2003; 88(4):1554-8. DOI: 10.1210/jc.2002-021518. View

20.

Halupczok-Zyla J, Gojny L, Bolanowski M . Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders. Endokrynol Pol. 2019; 70(4):350-356. DOI: 10.5603/EP.a2019.0022. View