Subclinical Hypercortisolism among Outpatients Referred for Osteoporosis
- Iacopo Chiodini, MD;
- Maria Lucia Mascia, MD;
- Silvana Muscarella, MD;
- Claudia Battista, MD;
- Salvatore Minisola, MD;
- Maura Arosio, MD;
- Stefano Angelo Santini, MD;
- Giuseppe Guglielmi, MD;
- Vincenzo Carnevale, MD; and
- Alfredo Scillitani, MD
- 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.
Abstract
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.
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
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Reproducible Research Statement:Study protocol and data set: Available to readers upon request. Statistical code: Not available.
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Requests for Single Reprints: Alfredo Scillitani, MD, Unit of Endocrinology, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, San Giovanni Rotondo, 71013, Foggia, Italy; e-mail, alscill{at}tin.it.
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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.
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Drs. Mascia, Muscarella, Battista, and Scillitani: Unit of Endocrinology, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
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Dr. Minisola: Department of Clinical Sciences, University “La Sapienza,” Rome, Italy.
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Dr. Santini: Department of Clinical Chemistry, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
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Dr. Guglielmi: Department of Radiology, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
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Dr. Carnevale: Department of Internal Medicine, “Casa Sollievo della Sofferenza” Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.
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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.
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Drafting of the article: I. Chiodini, A. Scillitani.
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Critical revision of the article for important intellectual content: S. Minisola, M. Arosio, G. Guglielmi, V. Carnevale, A. Scillitani.
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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.
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Statistical expertise: A. Scillitani.
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Collection and assembly of data: I. Chiodini, M.L. Mascia, S. Muscarella, C. Battista, S.A. Santini, A. Scillitani.
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