Background:
Hypercortisolism is known to cause osteoporosis.
Objective:
To evaluate the prevalence of subclinical hypercortisolism in participants referred for evaluation of osteoporosis.
Design:
Cross-sectional study.
Setting:
Two community hospitals and research institutes in Italy.
Patients:
219 patients without clinically overt hypercortisolism or other secondary causes of osteoporosis who were referred for evaluation of osteoporosis between January 2005 and December 2005.
Measurements:
Bone mineral density was measured by using dual-energy x-ray absorptiometry, and hypercortisolism was assessed with serum cortisol levels after a dexamethasone suppression test. Also measured were 24-hour urinary free cortisol levels and midnight plasma cortisol levels.
Results:
Seven of 65 patients with T-scores of 2.5 or less and vertebral fractures had subclinical hypercortisolism (prevalence, 10.8% [95% CI, 3.23% to 18.31%]). This prevalence was 4.8% (CI, 1.32% to 8.20%) among patients with osteoporosis. In multivariable analyses adjusted for age, sex, and body mass index, a positive dexamethasone suppression test result was associated with the presence of osteoporosis (odds ratio, 3.37 [CI, 1.78 to 6.43]; P < 0.001) and vertebral fractures (odds ratio, 1.70 [CI, 1.04 to 2.79]; P = 0.035).
Limitations:
The study was conducted in a referral setting; its findings may not apply to the general population.
Conclusions:
Subclinical hypercortisolism may be more common than is generally recognized in patients with osteoporosis in whom secondary causes of osteoporosis have been excluded.
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Author, Article, and Disclosure Information
From “San Giuseppe-Fatebenefratelli” Hospital, Fatebenefratelli Research Association, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, Scientific Institute, Milan, Italy; “Casa Sollievo della Sofferenza” Scientific Institute, San Giovanni Rotondo, Foggia, Italy; and University “La Sapienza,” Rome, Italy.
Disclosures: None disclosed.
Reproducible Research Statement:Study protocol and data set: Available to readers upon request. Statistical code: Not available.
Corresponding Author: Alfredo Scillitani, MD, Unit of Endocrinology, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, San Giovanni Rotondo, 71013, Foggia, Italy; e-mail, [email protected]
Current Author Addresses: Drs. Chiodini and Arosio: Department of Medical Sciences, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, Scientific Institute, Via F. Sforza 35, 20122, Milan, Italy.
Drs. Mascia, Muscarella, Battista, and Scillitani: Unit of Endocrinology, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
Dr. Minisola: Department of Clinical Sciences, University “La Sapienza,” Rome, Italy.
Dr. Santini: Department of Clinical Chemistry, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
Dr. Guglielmi: Department of Radiology, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
Dr. Carnevale: Department of Internal Medicine, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
Author Contributions: Analysis and interpretation of the data: I. Chiodini, M.L. Mascia, S. Muscarella, C. Battista, S. Minisola, M. Arosio, S.A. Santini, G. Guglielmi, V. Carnevale, A. Scillitani.
Drafting of the article: I. Chiodini, A. Scillitani.
Critical revision of the article for important intellectual content: S. Minisola, M. Arosio, G. Guglielmi, V. Carnevale, A. Scillitani.
Final approval of the article: I. Chiodini, S. Muscarella, C. Battista, S. Minisola, M. Arosio, G. Guglielmi, V. Carnevale, A. Scillitani, M.L. Mascia, S.A. Santini.
Statistical expertise: A. Scillitani.
Collection and assembly of data: I. Chiodini, M.L. Mascia, S. Muscarella, C. Battista, S.A. Santini, A. Scillitani.
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