The risk factors for fractures and trabecular bone-score value in patients with endogenous Cushing’s syndrome

Abstract

Young patients with CS have a low TBS. However, the only predictor of low traumatic fracture is the severity of the disease itself, indicated by high 24hUFC levels.

Assessment of vertebral microarchitecture in overt and mild Cushing's syndrome using trabecular bone score

“…Interestingly, almost all patients with alterations in BMD also displayed decreased TBS whilst 28.3% of patients with normal BMD exhibited decreased TBS. Similar discrepancies between BMD and TBS have only been described once in endogenous CS by Belaya et al These data are in accordance with the results of 2 large‐scale recent studies showing patients receiving glucocorticoids have lower TBS Z‐scores than glucocorticoid‐naïve patients without differences in their BMD Z‐scores . In addition, TBS alone and associated with BMD but not BMD alone was able to discriminate between glucocorticoid‐treated and glucocorticoid‐naïve women …”

“…Vertebral BMD is often normal or slightly decreased in Cushing's syndrome and fractures have been described in patients with normal BMD . Accordingly, only 24.5% of patients of our study with overt CS displayed decreased BMD.…”

“…Despite numerous studies acknowledging the importance of microarchitecture involvement in the physiopathology of glucocorticoid‐induced osteoporosis scanty reports on its assessment in Cushing's syndrome are available . Our study, conducted in a large number of patients with varying degrees of endogenous hypercortisolism suggests that TBS is a sensitive, informative tool assessing bone microarchitecture and stiffness in CS.…”

“…Indeed, subsequent studies conducted in patients receiving glucocorticoids have shown that TBS was more frequently altered than BMD and assessed more accurately the qualitative properties of the bone . Very few clinical studies using TBS in endogenous CS are available: one showed that TBS is more frequently altered than BMD in overt CS and one showed similar results in patients with mild autonomous cortisol excess (MACE) associated with adrenal incidentalomas . However, these studies deserve confirmation and the evolution of TBS after remission of hypercortisolism has not been studied.…”

Cushing's disease in older patients: Presentation and outcome

“…Previous reports are ambiguous about the predictive value of age on fractures in patients with CD. Zhanna et al found that the age of patients who had fractures was higher than patients who did not, although the difference was not significant. Trementino reported that the age of fractured versus nonfractured CS patients was not significantly different, but suggested that the fracture risk increased with longer exposure to hypercortisolemia .…”