Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing’s Syndrome

Stachowska, Barbara; Halupczok-Żyła, Jowita; Kuliczkowska-Płaksej, Justyna; Syrycka, Joanna; Bolanowski, Marek

doi:10.3389/fendo.2020.593173

Cited by 15 publications

(11 citation statements)

References 42 publications

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“…In this context, TBS appears to be a valuable tool in assessing the bone status and estimating fracture risk in patients with glucocorticoid-induced osteoporosis. It has been shown that in patients with endogenous hypercortisolemia TBS values were significantly lower than in controls, moreover, subjects with Cushing`s syndrome with fractures had low TBS values ( 29 ). However, the effect of exogenous glucocorticoids on bone may be different, because it is modulated by various mechanisms at a tissue level, like variations in the expression and sensitivity of the glucocorticoid receptors (GRs), the action of transmembrane transporters, and enzymatic metabolism of glucocorticoids to more or less active forms by 11β-hydroxysteroid dehydrogenases (11β-HSDs) ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

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Trabecular bone score and sclerostin concentrations in patients with primary adrenal insufficiency

et al. 2022

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BackgroundPatients with primary adrenal insufficiency need lifelong replacement therapy with glucocorticoids and mineralocorticoids, which may influence their bone quality.AimThe aim of the study was to evaluate densitometry parameters, trabecular bone score and sclerostin concentrations in patients with primary adrenal insufficiency in comparison to control group.Materials and methodsWe included 29 patients (62% females) with diagnose of autoimmune primary adrenal insufficiency (mean age 49.7 ± 11.7 years, mean duration of the disease 13.2± 13.6 years) and 33 healthy subjects (adjusted with age, sex and body mass index). Bone mineral density at the femoral neck, lumbar spine, total body and trabecular bone score were evaluated. Serum sclerostin concentrations were measured.ResultsThere were no significant differences in densitometry parameters (T-score, Z-score, bone mineral density in all locations) as well as in trabecular bone score in patients with adrenal insufficiency in comparison to control group. Mean serum sclerostin concentration was significantly higher in patients with adrenal insufficiency than in control group (44.7 ± 23.5 vs 30.7 ± 10.4 pmol/l, p=0.006). There was a negative correlation between trabecular bone score and the duration of adrenal insufficiency and age, also a negative correlation between femoral neck and total densitometry parameters and 24-hour urine cortisol as a marker of hydrocortisone daily dose in patients with adrenal insufficiency.ConclusionsThe bone status in patients with primary adrenal insufficiency was not impaired in comparison to control group, while sclerostin concentration was higher. The duration of the disease and higher hydrocortisone doses may affect negatively bone status.

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Section: Discussionmentioning

confidence: 99%

“…TBS is correlated with trabecular bone volume, the number of trabeculae and their connectivity ( 28 ). It has been shown, that in patients with endogenous hypercortisolemia TBS was significantly lower than in control group and correlated with disease duration ( 29 ).…”

Section: Introductionmentioning

confidence: 99%

Trabecular bone score and sclerostin concentrations in patients with primary adrenal insufficiency

et al. 2022

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“…In general, compared to control subjects, TBS was reported to be lower in patients with diabetes (42,(57)(58)(59), primary hyperparathyroidism (60)(61)(62)(63)(64), acromegaly (65)(66)(67)(68), anorexia nervosa (69,70), hypercortisolism (71)(72)(73), primary aldosteronism (especially in women) (74), with prolonged GC exposure (75)(76)(77)(78)(79)(80)(81)(82)(83)(84), rheumatoid arthritis and rheumatic disease (85)(86)(87), aromatase inhibition (88), kidney transplant recipients (89), as well as in patients on hemodialysis (90,91). In differentiated thyroid carcinomas, TBS was found to be lower in patients receiving long-term suppressive doses of thyroid-stimulating hormone than in patients receiving shorter-term therapy (92)(93)(94).…”

Section: Tbs and Fracture Risk Prediction In Patients With Diabetes A...mentioning

confidence: 93%

Update on trabecular bone score

Palomo¹,

Muszkat²,

Weiler³

et al. 2022

Archives of Endocrinology and Metabolism

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Trabecular bone score (TBS) is an indirect and noninvasive measure of bone quality. A low TBS indicates degraded bone microarchitecture, predicts osteoporotic fracture, and is partially independent of clinical risk factors and bone mineral density (BMD). There is substantial evidence supporting the use of TBS to assess vertebral, hip, and major osteoporotic fracture risk in postmenopausal women, as well as to assess hip and major osteoporotic fracture risk in men aged > 50 years. TBS complements BMD information and can be used to adjust the FRAX (Fracture Risk Assessment) score to improve risk stratification. While TBS should not be used to monitor antiresorptive therapy, it may be potentially useful for monitoring anabolic therapy. There is also a growing body of evidence indicating that TBS is particularly useful as an adjunct to BMD for fracture risk assessment in conditions associated with increased fracture risk, such as type-2 diabetes, chronic corticosteroid excess, and other conditions wherein BMD readings are often misleading. The interference of abdominal soft tissue thickness (STT) on TBS should also be considered when interpreting these findings because image noise can impact TBS evaluation. A new TBS software version based on an algorithm that accounts for STT rather than BMI seems to correct this technical limitation and is under development. In this paper, we review the current state of TBS, its technical aspects, and its evolving role in the assessment and management of several clinical conditions.

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“…Besides, cortisol can also improve recruitment of basic multicellular units in bone and then procuring the stimulation of bone turnover with the catabolic processes involved trabecular bone [8,9] . As a result, patients with hypercortisolism are prone to fracture despite normal or slightly lower BMD [10] . PHPT and hypercortisolism can directly or indirectly affect the PTH, which will also affect bone metabolism and bone quality, therefore, sex-, age-matched hypercortisolism patients were selected as a control group compared with PHPT patients.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Trabecular Bone Score (TBS) to Identify Bone Quality and Bone Fragility in Primary Hyperparathyroidism compared with Secondary Hyperparathyroidism——hypercortisolism patients

Tang

Jia

Wang

et al. 2022

Preprint

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Purpose: This study was designed to evaluates the effects of TBS, bone mineral density (BMD), and fracture risk in PHPT patients.Methods: The study group comprised 82 PHPT patients, and sex-, age-matched 50 hypercortisolism patients. The BMD and TBS were measured using DXA and TBS iNsight software. A receiver operating curve and logistic analysis were used to evaluate TBS. The FRAX index was calculated with and without the adjustment of TBS to evaluate the sensitivity and specificity of fracture risk. Results: Sixty-two per cent of PHPT patients exhibited degraded bone microstructure, thirty-nine per cent were diagnosed with osteoporosis by DXA. TBS had a moderately positive correlation with the lumbar spine, femoral neck, and total hip BMD. For PHPT patients, the BMD of the fracture group was lower compared to that of the non-fracture group, and the FRAX indexes were higher than that of the non-fracture group. There was no statistical difference in TBS between the fracture group and the non-fracture group. In hypercortisolism patients, there was no statistical difference in BMD and TBS between the fracture group and the non-fracture group. In PHPT patients, TBS was a predictor of osteoporosis even after adjusting for age, gender, and BMI (P = 0.001, OR = 0.120, 95% CI [0.033-0.435]); In contrast, TBS was not a predictor in hypercortisolism patients, regardless of whether adjusting confounding factors or not. The sensitivity of FRAX in the prediction of fracture risk in PHPT and hypercortisolism is higher than TBS alone. Conclusions: TBS combined with BMD can increase the diagnostic accuracy of PHPT patients. Moreover, FRAX is more sensitive to fracture prediction than TBS in patients with PHPT or hypercortisolism.

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Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing’s Syndrome

Cited by 15 publications

References 42 publications

Trabecular bone score and sclerostin concentrations in patients with primary adrenal insufficiency

Trabecular bone score and sclerostin concentrations in patients with primary adrenal insufficiency

Update on trabecular bone score

Usefulness of Trabecular Bone Score (TBS) to Identify Bone Quality and Bone Fragility in Primary Hyperparathyroidism compared with Secondary Hyperparathyroidism——hypercortisolism patients

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