Voltan Giacomo, Mazzeo Pierluigi, Cannito Michele, Pinelli Silvia, Barbot Mattia, Scaroni Carla, Ceccato Filippo, Camozzi Valentina
Department of Medicine DIMED, Endocrine Unit, University of Padova, 35128 Padua, Italy.
Endocrine Unit, University Hospital of Padova, 35128 Padua, Italy.
J Endocr Soc. 2025 Jan 17;9(3):bvaf008. doi: 10.1210/jendso/bvaf008. eCollection 2025 Feb 4.
Patients with endogenous Cushing syndrome (CS), in addition to significant cardiovascular morbidity, are burdened by a high prevalence of fragility fractures. Bone mineral density (BMD) alone poorly predicts the risk of fracture, and the implementation of trabecular bone score (TBS) is supported only by scant evidence. Indeed, reliable predictors of fractures in endogenous CS are still lacking.
This work aimed to analyze the prevalence and the potential predictors of fragility fractures in our patients with CS.
A monocentric, retrospective, cross-sectional study. A total of 51 patients with overt CS were enrolled. Main outcome measures included biochemical evaluation, BMD measurement, TBS evaluation, fracture presence, body composition evaluation, and arterial intima-media thickness (IMT) assessment.
Fragility fractures were found in 62.7% of patients at diagnosis. Fractured patients exhibited lower spine T-score ( = .03), longer disease duration ( = .025), higher waist circumference ( = .006), and predominantly male sex ( = .008). Increased serum uric acid levels ( = .001), greater IMT ( = .017), and higher prevalence of venous thromboembolism events (31.3% vs 5.3%, = .037) and atherosclerotic plaques (47% vs 5.3%, = .002) were described in the fracture group.Multivariable logistic regression identified the presence of atherosclerosis (OR 13.35; 95% CI 1.154-154.34, = .038) and osteoporosis (OR 11.30; 95% CI 1.55-82.56, = .017) as independent predictors. TBS values were inversely correlated with body mass index, fat and lean mass, and serum uric acid, and positively correlated with high-density lipoprotein cholesterol.
CS patients with higher overall burden of cardiovascular morbidity are more prone to experience fragility fractures.
内源性库欣综合征（CS）患者除了有显著的心血管疾病外，还面临着脆性骨折的高患病率。仅骨密度（BMD）难以预测骨折风险，而小梁骨评分（TBS）的应用仅有少量证据支持。事实上，内源性CS骨折的可靠预测指标仍然缺乏。
本研究旨在分析CS患者脆性骨折的患病率及潜在预测因素。
一项单中心、回顾性横断面研究。共纳入51例显性CS患者。主要观察指标包括生化评估、BMD测量、TBS评估、骨折情况、身体成分评估和动脉内膜中层厚度（IMT）评估。
62.7%的患者在诊断时发现有脆性骨折。骨折患者的脊柱T值较低（P = 0.03）、病程较长（P = 0.025）、腰围较高（P = 0.006），且男性居多（P = 0.008）。骨折组血清尿酸水平升高（P = 0.001）、IMT增加（P = 0.017）、静脉血栓栓塞事件的患病率较高（31.3%对5.3%，P = 0.037）和动脉粥样硬化斑块的患病率较高（47%对5.3%，P = 0.002）。多变量逻辑回归分析确定动脉粥样硬化（OR 13.35；95%CI 1.154 - 154.34，P = 0.038）和骨质疏松症（OR 11.30；95%CI 1.55 - 82.56，P = 0.017）为独立预测因素。TBS值与体重指数、脂肪和瘦体重以及血清尿酸呈负相关，与高密度脂蛋白胆固醇呈正相关。
心血管疾病总体负担较高的CS患者更容易发生脆性骨折。
