Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism
Abstract
Patients with adrenal incidentalomas (AIs) and subclinical hypercortisolism (SH) have increased risk of fracture independent of bone mineral density (BMD) and possibly due to reduced bone quality. The trabecular bone score (TBS) has been proposed as a index of bone microarchitecture. The aim of the study was to investigate TBS in AI. In 102 AI patients, SH was diagnosed in the presence of at least two of the following: (1) urinary free cortisol >70 µg/24 h (193.1 nmol/L); (2) cortisol after 1-mg dexamethasone suppression test (1-mg DST) >3.0 µg/dL (82.8 nmol/L); or (3) adrenocorticotropic hormone (ACTH) <10 pg/mL (<2.2 pmol/L). In patients and in 70 matched controls, BMD was measured at lumbar spine (LS) and femur (neck [FN] and total [FT]) by dual X-ray absorptiometry and TBS was assessed in the region of LS-BMD; BMD and TBS data were reported as Z-scores. In patients, vertebral deformities were assessed by radiograph. Patients with SH (n = 34) had lower LS-BMD (−0.31 ± 1.17), FT-BMD (−0.29 ± 0.91), and TBS (−3.18 ± 1.21) than patients without SH (n = 68, 0.31 ± 1.42, p = 0.03; 0.19 ± 0.97, p = 0.01; −1.70 ± 1.54, p < 0.0001, respectively) and controls (0.42 ± 1.52, p = 0.02; 0.14 ± 0.76, p = 0.02; −1.19 ± 0.99, p < 0.0001, respectively). TBS was inversely correlated with 1-mg DST (β = −0.26, t = −2.79, p = 0.006) regardless of age, LS-BMD, body mass index (BMI), and gender. The presence of fracture was associated with low TBS alone (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.85–12.42, p = 0.001) and with the cluster low TBS plus low LS-BMD (OR, 4.37; 95% CI, 1.71–11.4, p = 0.002), after adjustment for age, BMI, and gender. Low TBS plus low LS-BMD showed a good specificity (79%) for predicting fractures, whereas normal TBS (ie, > −1.5) plus normal LS-BMD high specificity (88.1%) for excluding fractures. Finally, TBS predicted the occurrence of a new fracture in 40 patients followed for 24 months (OR, 11.2; 95%CI, 1.71–71.41, p = 0.012) regardless of LS-BMD, BMI, and age. In SH, bone quality, as measured by TBS, is altered. TBS is useful in detecting AI patients at risk of fractures. © 2012 American Society for Bone and Mineral Research.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients with low BMD and low TBS are more likely to present fractures than patients with low BMD and high TBS.
“The patients with low BMD and low TBS will present fractures more likely than patients with low BMD and high TBS [16].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [16]
In adrenal incidentaloma patients with subclinical hypercortisolism, TBS is reduced and correlates with the number and severity of vertebral fractures and with the degree of cortisol excess.
“Eller-Vainicher et al. showed that, in AI patients with subclinical hypercortisolism, TBS is reduced and correlates with the number and severity of vertebral fractures and with the degree of cortisol excess [16].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [16]
Cites
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0125 · Cited by 2,718 · cited 1× · see citing works
“Indeed, the definition of SH is still controversial, due to the lack of specific signs and symptoms (by definition) of subclinical cortisol excess and to the possible fluctuation of cortisol secretion over time in AI patients.((2,35)) The difficulty in differentiating patients with and without SH explains, at least in…”
BackgroundDiagnosis and Treatment of Subclinical Hypercortisolism
Chiodini, I. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2722 · Cited by 279 · cited 13× · see citing works
“The comparison of continuous variables between Group SHþ, Group SH , and controls was performed using one-way ANOVA and Bonferroni post hoc analysis.”
BackgroundMethodInfluentialSelf-citationSubclinical Cushing’s syndrome in adrenal incidentalomas
Terzolo, M., Bovio, S., Reimondo, G., Pia, A., Osella, G., Borretta, G., & Angeli, A. (2005) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2005.01.008 · Cited by 179 · see citing works
Morelli, V., Masserini, B., Salcuni, A. S., Eller‐Vainicher, C., Savoca, C., Viti, R., Coletti, F., Guglielmi, G., Battista, C., Iorio, L., et al. (2010) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2010.03794.x · Cited by 107 · see citing works
Tauchmanova, L., Rossi, R., Nuzzo, V, del Puente, A., Esposito-del Puente, A., Pizzi, C., Fonderico, F., Lupoli, G., & Lombardi, G. (2001) · European Journal of Endocrinology · doi:10.1530/eje.0.1450241 · Cited by 79 · see citing works
Bone loss rate in adrenal incidentalomas: a longitudinal study
Chiodini, I., Torlontano, M., Carnevale, V., Guglielmi, G., Cammisa, M., Trischitta, V., & Scillitani, A. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.11.8022 · Cited by 69 · see citing works
Self-citationOsella, G., Reimondo, G., Peretti, P., Alì, A., Paccotti, P., Angeli, A., & Terzolo, M. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.2.7178 · Cited by 54 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Fassnacht, M., Arlt, W., Bancos, I., Dralle, H., Newell-Price, J., Sahdev, A., Tabarin, A., Terzolo, M., Tsagarakis, S., & Dekkers, O. M. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0467 · Cited by 1,566 · see citing works
Glucocorticoids and bone: consequences of endogenous and exogenous excess and replacement therapy
Hardy, R. S., Zhou, H., Seibel, M. J., & Cooper, M. S. (2018) · Endocrine Reviews · doi:10.1210/er.2018-00097 · Cited by 258 · see citing works
Mazziotti, G., Frara, S., & Giustina, A. (2018) · Endocrine Reviews · doi:10.1210/er.2018-00005 · Cited by 181 · see citing works
Utility of the trabecular bone score (TBS) in secondary osteoporosis
Ulivieri, F. M., Silva, B. C., Sardanelli, F., Hans, D., Bilezikian, J. P., & Caudarella, R. (2014) · Endocrine · doi:10.1007/s12020-014-0280-4 · Cited by 161 · see citing works
Self-citationMechanisms in endocrinology: endogenous subclinical hypercortisolism and bone: a clinical review
Chiodini, I., Vainicher, C. E., Morelli, V, Palmieri, S., Cairoli, E., Salcuni, A. S., Copetti, M., & Scillitani, A. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0289 · Cited by 73 · see citing works
Self-citationBilateral and unilateral adrenal incidentalomas: biochemical and clinical characteristics
Morelli, V, Palmieri, S., Salcuni, A. S., Eller-Vainicher, C., Cairoli, E., Zhukouskaya, V, Scillitani, A., Beck-Peccoz, P., & Chiodini, I. (2013) · European Journal of Endocrinology · doi:10.1530/eje-12-0777 · Cited by 62 · see citing works
Self-citationPalmieri, S., Morelli, V, Polledri, E., Fustinoni, S., Mercadante, R., Olgiati, L., Eller Vainicher, C., Cairoli, E., Zhukouskaya, V. V., Beck-Peccoz, P., et al. (2013) · European Journal of Endocrinology · doi:10.1530/eje-12-0803 · Cited by 57 · see citing works
Self-citationModern management of mild autonomous cortisol secretion
Delivanis, D. A., Athimulam, S., & Bancos, I. (2019) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.1551 · Cited by 46 · see citing works
Hwangbo, Y., Kim, J. H., Kim, S. W., Park, Y. J., Park, D. J., Kim, S. Y., Shin, C. S., & Cho, N. H. (2016) · Osteoporosis International · doi:10.1007/s00198-015-3270-3 · Cited by 34 · see citing works
Pituitary Disorders and Osteoporosis
Bolanowski, M., Halupczok, J., & Jawiarczyk-Przybyłowska, A. (2015) · International Journal of Endocrinology · doi:10.1155/2015/206853 · Cited by 27 · see citing works
- Authors
- Eller-Vainicher, C., Morelli, V., Ulivieri, F. M., Palmieri, S., Zhukouskaya, V. V., Cairoli, E., Pino, R., Naccarato, A., Scillitani, A., Beck-Peccoz, P., & Chiodini, I.
- Affiliations
- University of Milan (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Casa Sollievo della Sofferenza (IT)
- Unit of Endocrinology and Diabetology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda - Ospedale Maggiore Policlinico Department of Medical Sciences, University of Milan, Milan, Italy
- ORCID
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-05-01
- Volume
- 27
- Issue
- 10
- Pages
- 2223-2230
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- OpenAlex
- W2093042015
- Cited by
- 143
- References
- 7
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 7 · 2023: 13 · 2022: 8 · 2021: 9 · 2020: 4 · 2019: 14 · 2018: 14 · 2017: 7 · 2016: 16 · 2015: 12 · 2014: 8 · 2013: 9 · 2012: 4
- FWCI
- 11.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- trabecular bone score, bone quality, bone microarchitecture, adrenal incidentaloma, subclinical hypercortisolism, bone mineral density, fracture risk, dexamethasone suppression test, ACTH, vertebral deformity, Cushing's syndrome, osteoporosis, Cushing's disease, ectopic ACTH syndrome, adrenal adenoma
- MeSH terms
- Adrenocortical Hyperfunction, Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Bone and Bones, Female, Humans, Hydrocortisone, Italy, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Spine, Bone Density, Prevalence, Logistic Models, Odds Ratio, Spinal Fractures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
