High bone marrow fat in patients with Cushing's syndrome and vertebral fractures
High bone marrow fat in patients with Cushing's syndrome and vertebral fractures
复制标题
DOI：
10.1007/s12020-019-02034-4
复制
发表时间：
2020-01-01
期刊：
影响因子：
3.7
通讯作者：
Cannavo, Salvatore
中科院分区：
文献类型：
--
作者：
Ferrau, Francesco;Giovinazzo, Salvatore;Cannavo, Salvatore
目的评价库欣综合征（CS）的骨骼脆性是一个临床挑战，因为双能X线吸收法（DXA）不能捕捉到糖皮质激素过量引起的骨微结构异常。高皮质醇血症被证明会增加骨髓肥胖，但在这种临床环境下，通过脊椎磁共振波谱测量的高骨髓脂肪（BMF）是否可以预测骨折风险仍然是未知的。在这项横断面研究中，我们评估了BMF和椎体骨折（VFs）在CS患者之间的关联。方法20例（5 M，年龄44 +/- 13岁）与活跃的CS进行了评估形态学VFs，腰椎BMF，骨密度（BMD）。15名健康志愿者结果CS患者的BMF显著高于对照组（P <0.05），CS患者的BMF显著高于对照组（P <0.05），CS患者的BMF显著高于对照组（P <0.05），CS患者的BMF显著高于对照组（P <0.05），CS患者的BMF显著高于对照组（P <0.05）。（52.0% vs27.0%，P < 0.01），且与患者年龄直接相关（p = 0.03）、24小时无尿皮质醇（p = 0.03）、午夜血清皮质醇（p = 0.02）和血清CTX（p = 0.01）。VF患者（13例）的BMF显著高于无VF患者（65.0% vs. 24.0%，p = 0.03）。BMD正常或骨量减少的骨折患者的BMF与骨质疏松或年龄低BMD的骨折患者相当（p = 0.71）。当分析仅限于正常的BMD或骨量减少的患者，VF仍然显着与较高的BMF（p = 0.05）。结论本研究提供了第一个证据，椎体肥胖可能是一个标志物皮质醇过多引起的骨骼脆性和测量脊柱BMF可以有一个作用，在诊断工作的骨折风险评估CS。
Purpose The evaluation of skeletal fragility in Cushing's syndrome (CS) is a clinical challenge, since dual-energy X-ray absorptiometry (DXA) does not capture abnormalities in bone microstructure induced by glucocorticoid excess. Hyper-cortisolism was shown to increase bone marrow adiposity, but it is still unknown whether high bone marrow fat (BMF) as measured by vertebral magnetic resonance spectroscopy may predict fracture risk in this clinical setting. In this cross-sectional study, we evaluated the association between BMF and vertebral fractures (VFs) in patients with CS.Methods Twenty patients (5 M, age 44 +/- 13 years) with active CS were evaluated for morphometric VFs, lumbar spine BMF, and bone mineral density (BMD). Fifteen healthy volunteers (4 M, age 43 +/- 12 years) acted as control group for BMF evaluation.Results BMF was significantly higher in CS patients vs. controls (52.0% vs. 27.0%, p < 0.01), and was directly correlated with patients' age (p = 0.03), 24-hours urine-free cortisol (p = 0.03), midnight serum cortisol (p = 0.02), and serum CTX (p = 0.01). Patients with VFs (13 cases) showed significantly higher BMF vs. patients without VFs (65.0% vs. 24.0%, p = 0.03). Fractured patients with either normal BMD or osteopenia showed comparable BMF to fractured patients with either osteoporosis or low BMD for age (p = 0.71). When the analysis was restricted to patients with normal BMD or osteopenia, VFs were still significantly associated with higher BMF (p = 0.05).Conclusions This study provides a first evidence that vertebral adiposity may be a marker of hypercortisolism-induced skeletal fragility and measurement of spine BMF could have a role in the diagnostic work-up for the assessment of fracture risk in CS.