Primary aldosteronism as a cause of secondary osteoporosis.
Primary aldosteronism as a cause of secondary osteoporosis.
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DOI：
10.1530/eje-17-0417
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发表时间：
2017-08
影响因子：
5.8
通讯作者：
A. Salcuni;V. Carnevale;C. Battista;S. Palmieri;C. Eller-Vainicher;V. Guarnieri;F. Pugliese;G. Guglielmi;G. Desina;S. Minisola;I. Chiodini;A. Scillitani
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文献类型：
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作者：
A. Salcuni;V. Carnevale;C. Battista;S. Palmieri;C. Eller-Vainicher;V. Guarnieri;F. Pugliese;G. Guglielmi;G. Desina;S. Minisola;I. Chiodini;A. Scillitani
目的原发性醛固酮增多症(PA)患者骨质疏松症(OP)和骨折(FX)的发生率较高。我们评估了代谢性骨病门诊患者中PA的存在。设计研究在转诊的意大利内分泌科的住院和门诊基础上进行。方法对2632例患者进行评估。2310人被排除在外，因为他们服用了已知会影响骨骼或盐皮质激素代谢的药物，或者被诊断为骨质疏松症的继发性原因。其余322名受试者(304名女性，18名男性)参与了这项研究。采用双能X线骨密度仪进行骨密度和胸腰椎椎体形态测量。所有患者均用醛固酮/肾素比值筛查PA。对于那些结果呈阳性的人，进行了确证测试。结果322例受试者中，骨质疏松药物213例，非骨质疏松药物109例。骨质疏松组11例(5.2%)，非骨质疏松组1例(0.9%，P=0.066)。26.1%伴有骨质疏松、高血压和高钙尿的患者出现PA。与无PA组比较，PA组尿钙排泄量(4.8±2.5)mmo1/d比7.6±3.2mmo1/d(P<0.001.0 1)和血清甲状旁腺素水平(5.4pmo1/L vs7.3pmo1/L，P<0.0 1)显著升高。结论PA应列为继发性OP的原因之一。
OBJECTIVE Patients with primary aldosteronism (PA) have a high prevalence of osteoporosis (OP) and fractures (Fx). We evaluated the presence of PA in patients admitted to our metabolic bone disease outpatient clinic. DESIGN Study conducted on an in- and outpatient basis in a referral Italian endocrinology unit. METHODS A total of 2632 patients were evaluated. 2310 were excluded because they were taking drugs known to affect bone or mineralocorticoids metabolism or were diagnosed to have a secondary cause of osteoporosis. The remaining 322 subjects (304 females, 18 males) took part in the study. Bone mineral density (BMD) and thoracic and lumbar spine vertebral morphometry were performed by dual X-ray absorptiometry. All patients were screened for PA with aldosterone-to-renin ratio. In those who had positive results, confirmatory tests were performed. RESULTS Among 322 subjects, 213 were osteoporotics and 109 were not. PA was diagnosed in eleven out of 213 osteoporotic patients (5.2%) and one out of 109 non-osteoporotic subjects (0.9%, P = 0.066). PA was observed in the 26.1% of patients with the concomitant presence of osteoporosis, hypertension and hypercalciuria. Compared with patients without PA, patients with PA had mean values of urinary calcium excretion, 4.8 ± 2.5 mmol/day vs 7.6 ± 3.2 mmol/day, P < 0.001 and serum PTH levels, 5.4 pmol/L vs 7.3 pmol/L, P < 0.01, significantly higher. CONCLUSIONS PA should be considered among the causes of secondary OP.