Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wrocław, Poland.
Front Endocrinol (Lausanne). 2021 Jan 21;11:593173. doi: 10.3389/fendo.2020.593173. eCollection 2020.
The impairment in bone microarchitecture and reduced bone quality are relevant mechanisms underlying the increased fracture risk in Cushing's syndrome (CS). The trabecular bone score (TBS) is a relatively novel textural index of bone microarchitecture.
The objective of the study was to compare TBS, bone mineral density (BMD), and fracture risk in patients with endogenous CS to controls. We have investigated the association of TBS with anthropometric parameters and 25(OH) vitamin D concentrations.
The study group comprised 19 consecutive patients with CS (14 women and 5 men; mean age 45.84 ± 13.15 years) and sex-, age-matched 36 controls (25 women and men; mean age 52.47 ± 8.98 years). Anthropometric parameters, biochemical and hormonal data were compared between groups. Lumbar spine (L1-L4) and femoral neck BMD (LS BMD, FN BMD) measurements were performed. TBS values were obtained from lumbar spine DXA images.
TBS was significantly lower in patients with CS compared to controls (p = 0.0002). The 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture were significantly higher in the CS group than in controls (p = 0.03, p < 0.0001, respectively). All subjects from the CS group with fractures had low TBS value (degraded microarchitecture). TBS correlated negatively with the duration of disease in patients with CS (r = -0.590 p = 0.008).
The patients with active CS have altered bone microstructure as indicated by the decreased TBS and are at higher risk of hip and a major osteoporotic fractures. TBS seems to be a very important analytical tool facilitating fracture risk assessment in endogenous hypercortisolism.
在库欣综合征（CS）中，骨微结构的损害和骨质量的降低是导致骨折风险增加的相关机制。骨小梁评分（TBS）是一种相对新颖的骨微结构纹理指数。
本研究的目的是将 CS 患者的 TBS、骨密度（BMD）和骨折风险与对照组进行比较。我们研究了 TBS 与人体测量参数和 25（OH）维生素 D 浓度的相关性。
研究组包括 19 例连续的 CS 患者（14 名女性和 5 名男性；平均年龄 45.84 ± 13.15 岁）和年龄匹配的 36 名对照组（25 名女性和男性；平均年龄 52.47 ± 8.98 岁）。比较两组的人体测量参数、生化和激素数据。进行腰椎（L1-L4）和股骨颈 BMD（LS BMD、FN BMD）测量。从腰椎 DXA 图像中获得 TBS 值。
CS 患者的 TBS 值明显低于对照组（p = 0.0002）。CS 组的髋部骨折 10 年概率和主要骨质疏松性骨折 10 年概率均显著高于对照组（p = 0.03，p < 0.0001）。CS 组所有骨折患者的 TBS 值均较低（微结构退化）。TBS 与 CS 患者的疾病持续时间呈负相关（r = -0.590，p = 0.008）。
活动期 CS 患者的骨微结构发生改变，表现为 TBS 降低，髋部和主要骨质疏松性骨折风险增加。TBS 似乎是一种非常重要的分析工具，有助于评估内源性皮质醇增多症的骨折风险。
