Center for Bone Diseases, Rheumatology Unit, Bone and Joint Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
Endocrinology, Diabetology, and Metabolism Unit, Internal Medicine Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.
J Clin Endocrinol Metab. 2017 Jul 1;102(7):2628-2636. doi: 10.1210/jc.2016-3804.
Increased evening cortisol levels have been implicated in bone mineral density (BMD) loss. The effect on bone microarchitecture and fracture risk has never been studied.
To study the relationship between salivary cortisol circadian rhythm and (1) trabecular bone score (TBS) and (2) fracture prevalence.
DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: Cross-sectional study including 608 women >50 years old (mean = 65.5) from the OsteoLaus cohort. Data included the FRAX© questionnaire, BMD, TBS and vertebral fracture (VFx) assessment by dual X-ray absorptiometry, and measures of salivary cortisol (awakening, 30 minutes thereafter, 11 am, and 8 pm).
In the multivariate model, participants in the highest tertile of 8 pm salivary cortisol (sc-8 pm) (mean = 5.7 ± 2.5 nmol/L) vs lowest tertile (1.7 ± 0.4 nmol/L) had lower TBS values (1.27 vs 1.29; P = 0.02), more prevalent VFx grades 2 and 3 (odds ratio = 5.34; P = 0.012), low-trauma fractures (odds ratio = 1.80; P = 0.036), and major osteoporotic fractures (odds ratio = 1.96; P = 0.042), without difference in lumbar spine BMD (0.91 vs 0.92 g/cm2; P = 0.431). VFx prevalence was associated with sc-8 pm and TBS independently of each other and of other risk factors. The cut-point for sc-8 pm correlating with the presence of >1 VFx was 3.62 nmol/L (sensitivity 0.74, specificity 0.66).
High sc-8 pm is associated with low TBS and an increased prevalence of radiologic VFx independently of other risk factors. Measurement of sc-8 pm may add relevant information in the assessment of fracture risk.
夜间皮质醇水平升高与骨密度（BMD）下降有关。皮质醇昼夜节律对骨微结构和骨折风险的影响尚未得到研究。
研究唾液皮质醇昼夜节律与（1）骨小梁评分（TBS）和（2）骨折发生率之间的关系。
设计、地点、患者和干预措施：这是一项包括来自 OsteoLaus 队列的 608 名年龄>50 岁（平均年龄 65.5 岁）女性的横断面研究。数据包括 FRAX©问卷、BMD、TBS 和双能 X 线吸收法评估的椎体骨折（VFx），以及唾液皮质醇（觉醒时、30 分钟后、11 时和 8 时）的测量值。
在多变量模型中，8 时唾液皮质醇（sc-8 pm）最高三分位组（均值=5.7±2.5 nmol/L）与最低三分位组（1.7±0.4 nmol/L）相比，TBS 值较低（1.27 与 1.29；P=0.02），更常见的 VFx 等级 2 和 3（比值比=5.34；P=0.012）、低创伤性骨折（比值比=1.80；P=0.036）和主要骨质疏松性骨折（比值比=1.96；P=0.042），而腰椎 BMD 无差异（0.91 与 0.92 g/cm2；P=0.431）。VFx 发生率与 sc-8 pm 和 TBS 相关，彼此独立，且与其他危险因素无关。与存在>1 个 VFx 相关的 sc-8 pm 切点为 3.62 nmol/L（灵敏度 0.74，特异性 0.66）。
高 sc-8 pm 与低 TBS 和放射学 VFx 发生率增加相关，与其他危险因素无关。sc-8 pm 的测量可能会在评估骨折风险时提供相关信息。
