Subclinical hypercortisolism among outpatients referred for osteoporosis

Iacopo Chiodini, Maria Lucia Mascia, Silvana Muscarella, Claudia Battista, Salvatore Minisola, Maura Arosio, Stefano Angelo Santini, Giuseppe Guglielmi, Vincenzo Carnevale, Alfredo Scillitani

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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 dualenergy 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.

Original languageEnglish
Pages (from-to)541-548
Number of pages8
JournalAnnals of Internal Medicine
Volume147
Issue number8
Publication statusPublished - Oct 16 2007

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Cushing Syndrome
Osteoporosis
Outpatients
Hydrocortisone
Dexamethasone
Odds Ratio
Community Hospital
Bone Density
Italy
Body Mass Index
Referral and Consultation
Cross-Sectional Studies
X-Rays
Serum

ASJC Scopus subject areas

  • Medicine(all)

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Subclinical hypercortisolism among outpatients referred for osteoporosis. / Chiodini, Iacopo; Mascia, Maria Lucia; Muscarella, Silvana; Battista, Claudia; Minisola, Salvatore; Arosio, Maura; Santini, Stefano Angelo; Guglielmi, Giuseppe; Carnevale, Vincenzo; Scillitani, Alfredo.

In: Annals of Internal Medicine, Vol. 147, No. 8, 16.10.2007, p. 541-548.

Research output: Contribution to journalArticle

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AU - Arosio, Maura

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