J Korean Soc Spine Surg.  2017 Mar;24(1):1-6. 10.4184/jkss.2017.24.1.1.

Risk Factors for Osteoporotic Vertebral Fracture in Cushing Syndrome

Affiliations
  • 1Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Korea. faridat80@gmail.com

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
The goal of this study was to evaluate the risk factors of osteoporotic vertebral fractures (OVFs) in patients with Cushing syndrome. SUMMARY OF LITERATURE REVIEW: In most reports, vertebral fractures in Cushing syndrome have been found to be related to osteoporosis. However, few studies have analyzed the clinical risk factors for OVFs.
MATERIALS AND METHODS
Thirty-two patients with Cushing syndrome who visited the orthopaedic department complaining of back pain were included in this study. Standing lateral X-rays were performed to evaluate the presence of vertebral fractures, and bone mineral density (BMD) was measured.
RESULTS
Of the 32 patients with Cushing syndrome with back pain, 8 (25%) were diagnosed with OVFs using morphometric criteria. The average weight and body mass index of the vertebral fracture group (VF group) were significantly higher than the values observed in the non-vertebral fracture group (non-VF group) (p=0.004, p=0.018). Lumbar BMD was significantly lower in the VF group (p=0.006). A risk factor for OVFs in Cushing syndrome was osteoporosis (odds ratio=18.56, 95% confidence interval=1.72-200.21, p=0.016) regardless of gender, obesity, menopause, or urine free cortisol levels.
CONCLUSIONS
OVFs in Cushing syndrome have been associated with overweight, and overweight is an indicator of compliance in the treatment of Cushing syndrome. Therefore, weight reduction and the prevention of osteoporosis should be emphasized in patients with Cushing syndrome to prevent OVFs.

Keyword

Cushing syndrome; Vertebral fracture; Osteoporosis

MeSH Terms

Back Pain
Body Mass Index
Bone Density
Compliance
Cushing Syndrome*
Female
Humans
Hydrocortisone
Menopause
Obesity
Osteoporosis
Overweight
Retrospective Studies
Risk Factors*
Weight Loss
Hydrocortisone

Figure

  • Fig. 1. Radiograph of a 21-year-old female patient who was diagnosed with an L3 compression fracture.

  • Fig. 2. Radiograph of a 38-year-old female patient with no compression fracture.


Reference

1. Cushing H. The basophil adenomas of the pituitary body. Ann R Coll Surg Engl. 1969; 44:180–1.
2. Rodino MA, Shane E. Osteoporosis after organ transplan-tation. Am J Med. 1998; 104:459–69.
Article
3. Canalis E. Clinical review 83: Mechanisms of glucocorticoid action in bone: implications to glucocorticoid-induced osteoporosis. J Clin Endocrinol Metab. 1996; 81:3441–7.
Article
4. Freehill AK, Lenke LG. Severe kyphosis secondary to glucocorticoid-induced osteoporosis in a young adult with Cushing's disease. A case report and literature review. Spine (Phila Pa 1976). 1999; 24:189–93.
5. Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005; 16(Suppl):S3–7.
Article
6. Tauchmanova L, Pivonello R, Di Somma C, et al. Bone de-mineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status. J Clin Endocrinol Metab. 2006; 91:1779–84.
7. Davies KM, Stegman MR, Heaney RP, et al. Prevalence and severity of vertebral fracture: the Saunders County Bone Quality Study. Osteoporos Int. 1996; 6:160–5.
Article
8. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002; 359:1761–7.
Article
9. Smith-Bindman R, Cummings SR, Steiger P, et al. A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res. 1991; 6:25–34.
Article
10. Reid IR. Glucocorticoid osteoporosis–mechanisms and management. Eur J Endocrinol. 1997; 137:209–17.
Article
11. Israel E, Banerjee TR, Fitzmaurice GM, et al. Effects of in-haled glucocorticoids on bone density in premenopausal women. N Engl J Med. 2001; 345:941–7.
Article
12. Manning PJ, Evans MC, Reid IR. Normal bone mineral density following cure of Cushing's syndrome. Clin Endocrinol (Oxf). 1992; 36:229–34.
Article
13. Schousboe JT, Vokes T, Broy SB, et al. Vertebral Fracture Assessment: the 2007 ISCD Official Positions. J Clin Densi-tom. 2008; 11:92–108.
Article
14. Reid IR, Ibbertson HK, France JT, et al. Plasma testosterone concentrations in asthmatic men treated with glucocorticoids. Br Med J (Clin Res Ed). 1985; 291:574.
Article
15. Torlontano M, Chiodini I, Pileri M, et al. Altered bone mass and turnover in female patients with adrenal incidentaloma: the effect of subclinical hypercortisolism. J Clin Endocrinol Metab. 1999; 84:2381–5.
Article
16. Sipahi S, Tuzun S, Ozaras R, et al. Bone mineral density in women with sarcoidosis. J Bone Miner Metab. 2004; 22:48–52.
17. De Martin M, Pecori Giraldi F, Cavagnini F. Cushing's disease. Pituitary. 2006; 9:279–87.
Article
18. Canalis E, Bilezikian JP, Angeli A, et al. Perspectives on glu-cocorticoid-induced osteoporosis. Bone. 2004; 34:593–8.
Article
19. Di Somma C, Colao A, Pivonello R, et al. Effectiveness of chronic treatment with alendronate in the osteoporosis of Cushing's disease. Clin Endocrinol (Oxf). 1998; 48:655–62.
Article
20. Center JR, Nguyen TV, Schneider D, et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999; 353:878–82.
Article
21. Diacinti D, Pisani D, Barone-Adesi F, et al. A new predictive index for vertebral fractures: the sum of the anterior vertebral body heights. Bone. 2010; 46:768–73.
Article
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