Bone mineral density and bone turnover before and after surgical cure of Cushing's syndrome.

Abstract

We measured bone mineral density (BMD) using dual-energy x-ray absorptiometry in 20 patients with Cushing's syndrome (CS) (14 preand 2 postmenopausal women, 4 men) before and in 18 of them also at regular intervals after surgical cure (median duration of follow-up, 36 months). In addition, in the premenopausal women with CS, fast ing blood samples and 2-h fasting urine samples for measurement of biochemical parameters of bone and collagen metabolism were col lected before and in 9 of them also at regular intervals during the first 2 yr after surgery. Marked osteopenia was present in'most patients with active CS (Z-scores: lumbar spine -1.45 ± 1,44 and femoral neck ~ 1.50 ± 1 .02; mean ± sd). No consistent change in BMD was observed at 3 and 6 months after surgery. Thereafter BMD increased consid erably in almost all patients. For the 15 patients with a follow-up of at least 1 yr, Z-scores at the last evaluation were -0.65 ± 1.27 for the lumbar spine and -0.98 ± 1.02 for the femoral neck (both/5 < 0.002 compared with pretreatment values). In the premenopausal patients, the increase in BMD both in the lumbar spine and in the femoral neck at 24 months was inversely correlated with age (r = -0.733, P < 0.03, and r ~ -0.667, P < 0.05, respectively). Serum levels of osteocalcin, bone alkaline phosphatase, carboxyterminal propeptide of type I pro

Body composition and bone mineral density in women with Cushing's syndrome in remission and the association with common genetic variants influencing glucocorticoid sensitivity

“…The median (interquartile rage) time in remission was 13 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) years. Nineteen (38%) patients were receiving GC replacement therapy: ten after bilateral adrenalectomy, seven due to pituitary insufficiency after transsphenoidal pituitary surgery and/or radiotherapy and two after unilateral adrenalectomy.…”

“…Prospective studies have demonstrated improved BMD following treatment of CS (12,13,14). However, these studies have small numbers of patients, short follow-up time and/or lack a control group.…”

Bone turnover in patients with endogenous Cushing’s syndrome before and after successful treatment

“…Bone formation, evaluated most frequently with osteocalcin (OC) measurements, was found to be greatly suppressed in most [3][4][5][6][7] but not all studies [8][9][10], while aminoterminal propeptide of type 1 procollagen was less suppressed or even normal in these patients. On the other hand, conflicting data have been reported on the rate of bone resorption in patients with endogenous hypercortisolism, as resorption markers have been found to be normal [5,6,11], decreased [6,7,12], and even increased [9,10,13,14].…”

“…While most authors showed an increase in BMD at most skeletal sites and in the total skeleton [8,10,[16][17][18][19] accompanied with a rapid increase in serum OC levels, the exact time course of these changes has not been explored yet. Using dual photon X-ray absorptiometry, our recent study indicated a redistribution of bone mineral content from the peripheral to the axial skeleton after the cure of CS [19].…”

Urinary deoxypyridinoline is a BMD-independent marker for prevalent vertebral fractures in postmenopausal women treated with glucocorticoid

“…GC administration causes bone loss and an increase in bone fragility, resulting in a great increase in fracture risk [1][2][3][4][5]. Excessive intrinsic GC due to Cushing's syndrome is associated with increased bone resorption markers, decreased bone mineral density (BMD) and increased fracture risk [6][7][8][9][10]. However, a metaanalysis of prior GC use and fracture risk suggested that fracture risk was explained only partly by BMD [3].…”