Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how?
Abstract
Guidelines for the management of osteoporosis induced by endogenous hypercortisolism are not available. Both the American College of Rheumatology and the International Osteoporosis Foundation recommend to modulate the treatment of exogenous glucocorticoid-induced osteoporosis (GIO) based on the individual fracture risk profile (calculated by FRAX) and dose of glucocorticoid used, but it is difficult to translate corticosteroid dosages to different degrees of endogenous hypercortisolism, and there are no data on validation of FRAX stratification method in patients with endogenous hypercortisolism. Consequently, it is unclear whether such recommendations may be adapted to patients with endogenous hypercortisolism. Moreover, patients with exogenous GIO take glucocorticoids since suffering a disease that commonly affects bone. On the other hand, the correction of coexistent risk factors, which may contribute to increase the fracture risk in patients exposed to glucocorticoid excess, and the removal of the cause of endogenous hypercortisolism, may lead to the recovery of bone health. Although the correction of hypercortisolism and of possible coexistent risk factors is necessary to favor the normalization of bone turnover with recovery of bone mass; in some patients, the fracture risk could not be normalized and specific anti-osteoporotic drugs should be given. Who, when, and how the patient with endogenous hypercortisolism should be treated with bone-active therapy is discussed.
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In both endogenous and exogenous hypercortisolism, fractures may be asymptomatic and occur in patients with normal or only slightly decreased BMD values.
“In both endogenous and exogenous hypercortisolism fractures might be asymptomatic and occur in patients with normal or only slightly decreased BMD values [3, 10, 12].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [12]
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- Authors
- On behalf of ABC Group, Scillitani, A., Mazziotti, G., Di Somma, C., Moretti, S., Stigliano, A., Pivonello, R., Giustina, A., & Colao, A.
- Affiliations
- Casa Sollievo della Sofferenza (IT)
- Azienda Ospedaliera Carlo Poma (IT)
- Azienda Ospedaliera Sant'Andrea (IT)
- Federico II University Hospital (IT)
- Corresponding author
- Scillitani, A.
- Venue
- Osteoporosis International
- Published
- 2013-12-06
- Volume
- 25
- Issue
- 2
- Pages
- 441-446
- ISSN
- 0937-941X (ISSN-L)
- 1433-2965
- OpenAlex
- W1974492515
- Cited by
- 62
- References
- 46
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 8 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 1 · 2018: 7 · 2017: 3 · 2016: 5 · 2015: 7 · 2014: 5
- FWCI
- 5.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Osteoporosis International (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- endogenous hypercortisolism, Cushing's syndrome, glucocorticoid-induced osteoporosis, osteoporosis treatment, fracture risk, FRAX, osteoporosis drugs, bone turnover, glucocorticoid dose
- MeSH terms
- Cushing Syndrome, Glucocorticoids, Humans, Osteoporosis, Risk Factors, Bone Density Conservation Agents, Osteoporotic Fractures
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