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Cited by 135Bone health and osteoporosis researchAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

Risk of new vertebral fractures in patients with adrenal incidentaloma with and without subclinical hypercortisolism: A multicenter longitudinal study

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Morelli, Valentina, Eller-Vainicher, Cristina, Salcuni, Antonio Stefano, Coletti, Francesca, Iorio, Laura, Muscogiuri, Giovanna, Della Casa, Silvia, Arosio, Maura +3 more·2011·Journal of Bone and Mineral Research
DOI 10.1002/jbmr.398
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Abstract

In patients with adrenal incidentalomas (AIs), cross-sectional studies suggested the presence of an association between subclinical hypercortisolism (SH) and an increased prevalence of vertebral fractures (VFx) and spinal deformity index (SDI), which is a clinical index of bone quality. No longitudinal studies investigated the incidence of VFx and SDI changes over time in SH. The aim of this study was to evaluate VFx risk and SDI changes in SH over time. One-hundred-three consecutive AI patients were studied at baseline and after 12 and 24 months. Patients were divided into SH+ (n = 27) and SH– (n = 76) groups on the basis of the presence of two or more among urinary free cortisol greater than 70 µg/24 hours, serum cortisol after 1-mg dexamethasone suppression test greater than 3.0 µg/dL, and adrenocorticotropic hormone (ACTH) less than 10 pg/mL in 2 or more of the 3 evaluations. At baseline and after 24 months, bone mineral density (BMD) by dual-energy X-ray absorptiometry and the presence of VFx and SDI by summing the grade of deformity for each vertebra were evaluated. At the end of follow-up, the SH+ group showed a higher prevalence of VFx (81.5%) as compared with baseline (55.6%, p = .04) and a worsening of SDI (2.11 ± 1.85 versus 1.11 ± 1.47, p = .032) associated with SH regardless of age, gender, body mass index , BMD, baseline SDI, menopause duration [odds ratio (OR) = 12.3, 95% confidence interval (CI) 4.1–36.5, p = .001]. The incidence of new vertebral fractures was higher in the SH+ group (48%) than in the SH– group (13%; p = .001). It is concluded that subclinical hypercortisolism is associated with an increased risk of VFx and a possible deterioration of bone quality. © 2011 American Society for Bone and Mineral Research

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  • Patients with subclinical hypercortisolism showed higher fracture incidence despite stable BMD throughout observation.

    “Patients with SH showed higher fracture incidence in spite of stable BMD throughout the observation [13].”

    From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [13]

  • Factors other than BMD, such as bone quality, are associated with increased risk of fracture.

    “This suggests that factors other than BMD, such as bone quality, are associated with increased risk of fracture [7, 13].”

    From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [13]

  • Subclinical hypercortisolism might cause osteoporosis and increased risk of vertebral fractures.

    “It is thought that even subclinical hypercortisolism (SH) might be the cause of osteoporosis and increased risk of vertebral fractures [3, 13].”

    From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [13]

  • In adrenal incidentaloma patients, BMD was comparable between subjects with and without subclinical hypercortisolism, but the prevalence of vertebral fracture and spinal deformity index were significantly higher in those with subclinical hypercortisolism.

    “BMD in subjects with and without SH was comparable; however the prevalence of vertebral fracture and spinal deformity index (SDI) were significantly higher in SH subjects than in the group of patients without SH.”

    From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [13]

  • The presence of subclinical hypercortisolism was related to worsening of spinal deformity index and occurrence of a new vertebral fracture or progression of a preexisting vertebral deformity, regardless of age, gender, BMI, years since menopause, lumbar spine BMD, and basal SDI.

    “The presence of SH was related with worsening of SDI and occurrence of a new vertebral fracture or the progression of the grade of a preexisting vertebral deformity regardless of age, gender, BMI, years since menopause, lumbar spine BMD, and basal SDI.”

    From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [13]

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Authors
Morelli, V., Eller-Vainicher, C., Salcuni, A. S., Coletti, F., Iorio, L., Muscogiuri, G., Della Casa, S., Arosio, M., Ambrosi, B., Beck-Peccoz, P., & Chiodini, I.
Affiliations
  • University of Milan (IT)
  • Università Cattolica del Sacro Cuore (IT)
  • Department of Endocrinology and Metabolic Diseases, Università Cattolica del Sacro Cuore, Rome, Italy
  • Endocrinology and Diabetology Unit, Department of Medical Sciences, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Corresponding author
Chiodini, Iacopo
ORCID
Venue
Journal of Bone and Mineral Research
Publisher
Oxford University Press (OUP)
Published
2011-04-06
Volume
26
Issue
8
Pages
1816-1821
ISSN
  • 0884-0431 (ISSN-L)
  • 1523-4681
DOI
10.1002/jbmr.398
OpenAlex
W2001796090
Cited by
135
References
8
Citations by year
2026: 7 · 2025: 7 · 2024: 10 · 2023: 11 · 2022: 9 · 2021: 6 · 2020: 6 · 2019: 10 · 2018: 7 · 2017: 5 · 2016: 11 · 2015: 12 · 2014: 9 · 2013: 8 · 2012: 14
FWCI
11.55
Type
journal article
Language
en
Open access
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
adrenal incidentaloma, subclinical hypercortisolism, vertebral fractures, bone quality, bone mineral density, fracture risk, dexamethasone suppression test, urinary free cortisol, ACTH, menopause
MeSH terms
Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Cushing Syndrome, Female, Humans, Italy, Longitudinal Studies, Male, Middle Aged, Risk Factors, Logistic Models, Odds Ratio, Spinal Fractures

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