Spontaneous recovery of bone mass after cure of endogenous hypercortisolism
Erika Grossrubatscher1, Paolo Dalino Ciaramella1, Maria Elena Randazzo1, Angelo Vanzulli2 & Paola Loli1
Patients with Cushings syndrome (CS) commonly develop osteopeniaosteoporosis; the recovery of bone mass after remission of hypercortisolism is not well documented. The present study addresses this issue.
Patients and methods: Twenty patients (6M, 14F, 2 post-menopausal), aged 1564 years (median 36), 15 with Cushings disease, 2 with ectopic ACTH syndrome, 3 with ACTH-indipendent CS were studied. BMD (t and z scores) at lumbar spine and proximal femur were assessed by dual-energy X-ray absorptiometry before and 733 months (median 19) after successful surgical treatment of hypercortisolism. Five patients were treated with bisphosphonates. Four patients had hypogonadism (treated in two) and four untreated GH-deficiency.
Results: At baseline the spine (BMD, t score) appeared more damaged than the femur (P<0.01); femur BMD/t score were positively related with body mass index (BMI). A trend for a negative correlation between femur BMD/t score and age was observed. No correlations were observed between spine and femur BMD, z, t scores and the duration of disease or severity of hypercortisolism (UFC levels).
After cure of hypercortisolism a significant improvement in spine BMD (P=0.002), z (P=0.01) and t (P=0.001) scores and in femur z (P=0.02) and t (P=0.01) scores was observed with normalization in three patients; there was no significant difference in percent improvement of bone parameters between femur and spine. The increase in bone parameters at spine and femur was independent from BMD, t and z scores at baseline. The percent increase in spine t score was positively related with the time elapsed since cure (P=0.02). Treatment with bisphosphonates did not influence the recovery of bone mineralization.
Conclusions: Spontaneous improvement of steroid-induced osteoporosis after cure of hypercortisolism occurs both at spine and femur. The improvement is independent from basal conditions and treatment with bisphosphonates. The improvement at spine depends on time since cure.