Endocrine Abstracts

Introduction: Cushing’s Syndrome (CS) has been associated with bone mass abnormalities and with an increased risk of osteoporotic fractures.

Objective: Evaluate the effect of treatment on the 10-year probability of fracture predicted by FRAX^® and on the overall bone profile, in patients with CS.

Patients and Methods: We evaluated 36 patients (6 M, 30 F, 12 post-menopausal, mean-age 43.6±13.5), 22 with Cushing’s disease (CD), 10 with ACTH-independent CS (ACS) and 4 with ectopic ACTH syndrome. BMD, T-score and Z-score at lumbar spine and left femur and prevalence of vertebral fractures using dual-energy X-ray absorptiometry (DEXA) and the 10-year probability of fracture predicted by FRAX^® were assessed at baseline and after a 24 months median follow-up from cure of hypercortisolism. Six patients were on bisphosphonates (BSFs) treatment.

Results: At baseline 60% of patients showed bone mass abnormalities and 22% had vertebral fractures. Bone parameters did not differ between CD, ACS and ectopic CS. Bone mass abnormalities were not related to age, degree and duration of hypercortisolism. After a 24 months median follow-up from cure of hypercortisolism, a significant improvement in BMD, T-score and Z-score was observed with normalization in 7% of patients. There was no difference in percent increase at spine and femur between patients treated and untreated with BSFs. The 10-year probability of hip fracture (FRAX^® Hip) and of a major osteoporotic fracture (FRAX^® Major) was significantly reduced (respectively of 57% and of 48%) without difference between patients treated and untreated with BSFs. The FRAX^® Hip and FRAX^® Major percent reduction was related respectively with baseline neck femur and spine Z-score.

Conclusions: In CS patients, the cure of hypercortisolism is associated with recovery of bone mass and with significant reduction of the 10-year probability of osteoporotic fractures evaluated by FRAX^®. BSFs seem not to affect bone improvement.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.