Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Via Olgettina, 58, 20132, Milan, Italy.
Division of Endocrinology, Department of Medicine, Santiago de Compostela University (USC), Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
Pituitary. 2022 Oct;25(5):754-759. doi: 10.1007/s11102-022-01252-w. Epub 2022 Jul 18.
Skeletal complications are frequent and clinically relevant findings in Cushing's disease (CD) since an uncoupled suppressed bone formation and enhanced bone resorption leads to a marked skeletal damage with a rapid increase of fracture risk. Reduced Bone Mineral Density (BMD) has been consistently reported and osteopenia or osteoporosis are typical findings in patients with CD. Vertebral Fractures (VFs) are frequently reported and may occur even in patients with an only mild reduction of BMD, representing nowadays a still under- or misdiagnosed comorbidity of these patients being frequently asymptomatic. A novel approach combining different available tools such as BMD evaluation and vertebral morphometry, in order to improve diagnosis, management, and follow-up of bone comorbidity in all patients affected by CD, is needed. This approach is foreseen to be a crucial part of management of patients with CD, particularly in Pituitary Tumor Center of Excellence since VFs, the landmark of the bone involvement, may occur early in the history of the disease and may represent a relevant risk factor for further fractures, reduced quality of life and survival and need for pharmacologic prevention and treatment.
骨骼并发症是库欣病（CD）中常见且具有临床相关性的发现，因为去偶的骨形成抑制和骨吸收增强导致明显的骨骼损伤，骨折风险迅速增加。骨密度（BMD）降低已被一致报道，骨质疏松症或骨质疏松症是 CD 患者的典型表现。椎体骨折（VF）经常被报道，即使在 BMD 仅有轻度降低的患者中也可能发生，目前这些患者的这种并发症仍然存在诊断不足或误诊的情况，因为他们通常无症状。需要一种新的方法，结合不同的可用工具，如 BMD 评估和椎体形态计量学，以改善所有 CD 患者的骨骼并发症的诊断、管理和随访。这种方法有望成为 CD 患者管理的重要组成部分，特别是在垂体肿瘤卓越中心，因为椎体骨折是骨骼受累的标志，可能在疾病早期发生，并且可能是进一步骨折、生活质量和生存降低以及需要药物预防和治疗的相关风险因素。
