Subclinical Hypercortisolism among Outpatients Referred for Osteoporosis

  1. Iacopo Chiodini, MD;
  2. Maria Lucia Mascia, MD;
  3. Silvana Muscarella, MD;
  4. Claudia Battista, MD;
  5. Salvatore Minisola, MD;
  6. Maura Arosio, MD;
  7. Stefano Angelo Santini, MD;
  8. Giuseppe Guglielmi, MD;
  9. Vincenzo Carnevale, MD; and
  10. Alfredo Scillitani, MD
  1. 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

    • Potential Financial Conflicts of Interest: None disclosed.

    • Reproducible Research Statement:Study protocol and data set: Available to readers upon request. Statistical code: Not available.

    • 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.

    • 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.

    Summary for Patients

    • Summaries for Patients:How Common Are High Cortisol Levels in Apparently Healthy People with Osteoporosis? Ann Intern Med October 16, 2007 147:I-48
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    1. Ann Intern Med October 16, 2007 vol. 147 no. 8 541-548
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