Patients with adrenal incidentalomas and mild autonomous cortisol secretion may be at increased Risk of Vertebral Fractures

A recent study conducted in four Italian endocrinology units revealed an increased risk of vertebral fractures (VFx) in patients with adrenal incidentalomas (AI) and mild autonomous cortisol secretion (MACS). This study was published in The Journal of Clinical Endocrinology & Metabolism by Vittoria Favero and colleagues.

The study encompassed both cross-sectional and longitudinal analyses of retrospective data and involved 444 patients in the cross-sectional arm and 126 patients in the longitudinal arm, with a follow-up period averaging 24.9 ± 5.3 months.

Key Findings:

Prevalence of VFx:

• Among the patients in the cross-sectional arm, those with MACS exhibited a significantly higher prevalence of VFx, standing at 62.6%, compared to those without MACS, where the prevalence was notably lower at 22.9%.
• The study demonstrated a robust association between MACS and prevalent VFx, as evidenced by an odds ratio (OR) of 5.203, with a 95% Confidence Interval (CI) ranging from 3.361 to 8.055, and a highly statistically significant p-value of less than 0.001.
• The relative risk (RR) associated with this relationship was calculated at 2.07. Importantly, this association remained significant after adjusting for various factors, including age, body mass index (BMI), gender, bone mineral density at the spine (LS-BMD), and the presence of type 2 diabetes mellitus (T2D).

Incidence of VFx:

• In the longitudinal arm of the study, a cohort consisting of 66 patients without MACS and 60 patients with MACS was analyzed. Intriguingly, patients without MACS demonstrated a notably higher incidence of VFx at 36.4% compared to those with MACS, where the incidence was significantly lower at 10.0%.
• MACS continued to be associated with incident VFx, as reflected in a relative risk (RR) of 4.561, with a 95% CI spanning from 1.600 to 13.003, and a p-value of 0.005.
• This association remained consistent after adjusting for factors such as age, LS-BMD, gender distribution, the presence of prevalent VFx, and T2D.

Importantly, these associations held true when evaluating women and men separately. This study provides valuable insights into the increased risk of vertebral fractures in patients with adrenal incidentalomas and mild autonomous cortisol secretion (MACS). It underscores the importance of monitoring and managing bone health in these patients, irrespective of gender. Further research and clinical attention are warranted to better understand and address this heightened risk, ultimately improving patient outcomes.

Reference:

Favero, V., Eller-Vainicher, C., Morelli, V., Cairoli, E., Salcuni, A. S., Scillitani, A., Corbetta, S., Della Casa, S., Muscogiuri, G., Persani, L., & Chiodini, I. Increased risk of vertebral fractures in patients with mild autonomous cortisol secretion. The Journal of Clinical Endocrinology and Metabolism,2023 dgad560. https://doi.org/10.1210/clinem/dgad560