Ferraù Francesco, Giovinazzo Salvatore, Alessi Ylenia, Catalano Antonino, Tessitore Agostino, Mormina Enrico, Bellone Federica, Giuffrida Giuseppe, Paola Giuseppe, Cotta Oana Ruxandra, Ragonese Marta, Granata Francesca, Lania Andrea G, Mazziotti Gherardo, Cannavò Salvatore
Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
Unit of Endocrinology, "G. Martino" University Hospital, Messina, Italy.
Endocrine. 2023 May;80(2):441-447. doi: 10.1007/s12020-023-03318-6. Epub 2023 Feb 15.
Prediction of fragility fractures in Cushing syndrome (CS) is a challenge since dual energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD) does not capture all the alterations in bone microstructure induced by glucocorticoid excess. In this study we investigated the relationship between trabecular bone score (TBS), bone marrow fat (BMF) and vertebral fractures (VFs) in endogenous CS.
Cross-sectional.
Thirty subjects (7 M and 23 F, mean age 44.8 ± 13.4 yrs, range: 25-71) with active hypercortisolism were evaluated for VFs by quantitative morphometry, BMD and TBS by lumbar spine DXA and BMF by single-voxel magnetic resonance spectroscopy of vertebral body of L3.
Subjects with VFs (17 cases; 56.7%) had higher BMF (P = 0.014) and lower BMD T-score (P = 0.012) and TBS (P = 0.004) as compared to those without VFs. Prevalence of VFs resulted to be significantly higher in individuals with impaired TBS as compared to those with normal TBS (77.8% vs. 25.0%; P = 0.008). Among patients with VFs, only 6 (35.3%) had either osteoporosis or "low BMD for age". In logistic regression analysis, impaired TBS maintained the significant association with VFs [odds ratio (OR) 6.60, 95% C.I. 1.07-40.61; P = 0.042] independently of BMF (OR 1.03, 95% C.I. 0.99-1.08; P = 0.152).
TBS might be more accurate than BMF in identifying subjects with active CS and skeletal fragility at risk of VFs.
Excess in glucocorticoids is associated with alterations in bone remodeling and metabolism, leading to fragility fractures regardless of bone mineral density, making more challenging for the clinician the identification of high-risk population and the definition of preventing strategies. In this context, instrumental parameters suggestive of bone quality alterations and predictive of increased fracture risk are needed. In this study, we found CS patients to have bone quality alterations as indicated by the decreased trabecular bone score and increased bone marrow fat, as measured by DEXA and MRI respectively. Both parameters were associated with high risk of VFs, and were inversely correlated, although TBS seems to be more accurate than BMF in fractures prediction in this clinical setting.
由于双能X线吸收法（DXA）测量骨矿物质密度（BMD）无法捕捉到糖皮质激素过多引起的所有骨微结构改变，因此预测库欣综合征（CS）中的脆性骨折具有挑战性。在本研究中，我们调查了内源性CS中骨小梁骨评分（TBS）、骨髓脂肪（BMF）与椎体骨折（VF）之间的关系。
横断面研究。
对30例活动性皮质醇增多症患者（7例男性和23例女性，平均年龄44.8±13.4岁，范围：25 - 71岁）进行评估，通过定量形态学评估VF，通过腰椎DXA评估BMD和TBS，通过L3椎体的单体素磁共振波谱评估BMF。
与无VF的患者相比，有VF的患者（17例；56.7%）具有更高的BMF（P = 0.014）、更低的BMD T值（P = 0.012）和TBS（P = 0.004）。与TBS正常的个体相比，TBS受损的个体中VF的患病率显著更高（77.8%对25.0%；P = 0.008）。在有VF的患者中，只有6例（35.3%）患有骨质疏松症或“年龄相关低BMD”。在逻辑回归分析中，TBS受损与VF保持显著关联[比值比（OR）6.60，95%置信区间1.07 - 40.61；P = 0.042]，独立于BMF（OR 1.03，95%置信区间0.99 - 1.08；P = 0.152）。
在识别有活动性CS和有VF风险的骨骼脆性患者方面，TBS可能比BMF更准确。
糖皮质激素过多与骨重塑和代谢改变有关，导致无论骨矿物质密度如何都会发生脆性骨折，这使得临床医生识别高危人群和制定预防策略更具挑战性。在这种情况下，需要提示骨质量改变并预测骨折风险增加的工具参数。在本研究中，我们发现CS患者存在骨质量改变，分别通过DEXA和MRI测量显示为骨小梁骨评分降低和骨髓脂肪增加。这两个参数都与VF的高风险相关，并且呈负相关，尽管在这种临床情况下TBS在骨折预测方面似乎比BMF更准确。
