TY - JOUR
T1 - Bone involvement in aldosteronism
AU - Salcuni, Antonio Stefano
AU - Palmieri, Serena
AU - Carnevale, Vincenzo
AU - Morelli, Valentina
AU - Battista, Claudia
AU - Guarnieri, Vito
AU - Guglielmi, Giuseppe
AU - Desina, Gaetano
AU - Eller-Vainicher, Cristina
AU - Beck-Peccoz, Paolo
AU - Scillitani, Alfredo
AU - Chiodini, Iacopo
PY - 2012/10
Y1 - 2012/10
N2 - In rats with aldosteronism, a reduction of bone mineral density (BMD) and cortical bone strength has been reported. Our study was aimed to evaluate bone involvement in patients with primary aldosteronism (PA). A total of 188 consecutive subjects with adrenal incidentaloma, observed between November 2009 and October 2011, were screened for PA with aldosterone-to-renin ratio. After confirmatory tests, in those who screened positive, 11 patients were diagnosed as PA and 15 patients were not (nPA). A serum/urinary biochemical profile, parathyroid hormone (PTH), BMD measured at lumbar spine (LS) and total and femoral neck (TN and FN) by dual X-ray absorptiometry, and conventional spinal radiographs (T4-L4) were obtained in all subjects. PA patients had a significantly higher 24-hour urinary calcium (6.28 ± 1.85 versus 4.28 ± 1.18 mmol/d; p <0.01), and PTH (9.8 [5.8-14.6], median [range] versus 5.3 [2.5-10.8] pmol/L; p <0.01) than nPA patients. BMD expressed as Z-value at LS (-1.18 ± 0.99 versus 0.22 ± 1.12), FN (-0.85 ± 0.73 versus 0.01 ± 0.82), and TN (-0.49 ± 0.61 versus 0.39 ± 0.93) was lower in PA than in nPA (p = 0.003, p = 0.011, and p = 0.012, respectively). The prevalence of osteoporosis was higher in PA than in nPA (8/11, 72.7% versus 3/15, 20.0%; Fisher's exact test: p = 0.015). Vertebral fractures tended to be more prevalent in PA than in nPA (5/11, 45.5% versus 2/15, 13.3%; Fisher's exact test: p = 0.095). Logistic regression analysis showed that osteoporosis and morphometric vertebral fractures were associated with PA (odds ratio [OR], 15.4; 95% confidence interval [CI] = 1.83-130, p = 0.012; and OR, 30.4; 95%CI, 1.07-862, p = 0.045, respectively) regardless of age, body mass index (BMI), and LS-BMD. In 9 of 11 PA patients, 6 months after beginning of treatment (surgery or spironolactone) there was a significant reduction of urinary calcium excretion (p <0.01) and PTH (p <0.01), whereas in 5 of 11 PA patients, 1 year after beginning of treatment, BMD was significantly increased at LS, p <0.01). In conclusion, PA is associated with osteoporosis, vertebral fractures, and increased urinary calcium excretion.
AB - In rats with aldosteronism, a reduction of bone mineral density (BMD) and cortical bone strength has been reported. Our study was aimed to evaluate bone involvement in patients with primary aldosteronism (PA). A total of 188 consecutive subjects with adrenal incidentaloma, observed between November 2009 and October 2011, were screened for PA with aldosterone-to-renin ratio. After confirmatory tests, in those who screened positive, 11 patients were diagnosed as PA and 15 patients were not (nPA). A serum/urinary biochemical profile, parathyroid hormone (PTH), BMD measured at lumbar spine (LS) and total and femoral neck (TN and FN) by dual X-ray absorptiometry, and conventional spinal radiographs (T4-L4) were obtained in all subjects. PA patients had a significantly higher 24-hour urinary calcium (6.28 ± 1.85 versus 4.28 ± 1.18 mmol/d; p <0.01), and PTH (9.8 [5.8-14.6], median [range] versus 5.3 [2.5-10.8] pmol/L; p <0.01) than nPA patients. BMD expressed as Z-value at LS (-1.18 ± 0.99 versus 0.22 ± 1.12), FN (-0.85 ± 0.73 versus 0.01 ± 0.82), and TN (-0.49 ± 0.61 versus 0.39 ± 0.93) was lower in PA than in nPA (p = 0.003, p = 0.011, and p = 0.012, respectively). The prevalence of osteoporosis was higher in PA than in nPA (8/11, 72.7% versus 3/15, 20.0%; Fisher's exact test: p = 0.015). Vertebral fractures tended to be more prevalent in PA than in nPA (5/11, 45.5% versus 2/15, 13.3%; Fisher's exact test: p = 0.095). Logistic regression analysis showed that osteoporosis and morphometric vertebral fractures were associated with PA (odds ratio [OR], 15.4; 95% confidence interval [CI] = 1.83-130, p = 0.012; and OR, 30.4; 95%CI, 1.07-862, p = 0.045, respectively) regardless of age, body mass index (BMI), and LS-BMD. In 9 of 11 PA patients, 6 months after beginning of treatment (surgery or spironolactone) there was a significant reduction of urinary calcium excretion (p <0.01) and PTH (p <0.01), whereas in 5 of 11 PA patients, 1 year after beginning of treatment, BMD was significantly increased at LS, p <0.01). In conclusion, PA is associated with osteoporosis, vertebral fractures, and increased urinary calcium excretion.
KW - ADRENAL INCIDENTALOMA
KW - OSTEOPOROSIS
KW - PRIMARY ALDOSTERONISM
KW - URINARY CALCIUM EXCRETION
KW - VERTEBRAL FRACTURES
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UR - http://www.scopus.com/inward/citedby.url?scp=84866664731&partnerID=8YFLogxK
U2 - 10.1002/jbmr.1660
DO - 10.1002/jbmr.1660
M3 - Article
C2 - 22589146
AN - SCOPUS:84866664731
VL - 27
SP - 2217
EP - 2222
JO - Journal of Bone and Mineral Research
JF - Journal of Bone and Mineral Research
SN - 0884-0431
IS - 10
ER -