J Korean Soc Spine Surg.  2017 Mar;24(1):1-6. 10.4184/jkss.2017.24.1.1.

Risk Factors for Osteoporotic Vertebral Fracture in Cushing Syndrome

• Lee SH
• Park BM
• Song KS
• Lee SK
• Yoon SP
• Lee CC
• Lee BS
• Yang BS

• KMID: 2402836
• DOI: http://doi.org/10.4184/jkss.2017.24.1.1

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
The goal of this study was to evaluate the risk factors of osteoporotic vertebral fractures (OVFs) in patients with Cushing syndrome. SUMMARY OF LITERATURE REVIEW: In most reports, vertebral fractures in Cushing syndrome have been found to be related to osteoporosis. However, few studies have analyzed the clinical risk factors for OVFs.
MATERIALS AND METHODS
Thirty-two patients with Cushing syndrome who visited the orthopaedic department complaining of back pain were included in this study. Standing lateral X-rays were performed to evaluate the presence of vertebral fractures, and bone mineral density (BMD) was measured.
RESULTS
Of the 32 patients with Cushing syndrome with back pain, 8 (25%) were diagnosed with OVFs using morphometric criteria. The average weight and body mass index of the vertebral fracture group (VF group) were significantly higher than the values observed in the non-vertebral fracture group (non-VF group) (p=0.004, p=0.018). Lumbar BMD was significantly lower in the VF group (p=0.006). A risk factor for OVFs in Cushing syndrome was osteoporosis (odds ratio=18.56, 95% confidence interval=1.72-200.21, p=0.016) regardless of gender, obesity, menopause, or urine free cortisol levels.
CONCLUSIONS
OVFs in Cushing syndrome have been associated with overweight, and overweight is an indicator of compliance in the treatment of Cushing syndrome. Therefore, weight reduction and the prevention of osteoporosis should be emphasized in patients with Cushing syndrome to prevent OVFs.

Keyword

Cushing syndrome; Vertebral fracture; Osteoporosis

MeSH Terms

Back Pain
Body Mass Index
Bone Density
Compliance
Cushing Syndrome*
Female
Humans
Hydrocortisone
Menopause
Obesity
Osteoporosis
Overweight
Retrospective Studies
Risk Factors*
Weight Loss
Hydrocortisone

Figure

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  Fig. 1. Radiograph of a 21-year-old female patient who was diagnosed with an L3 compression fracture.

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  Fig. 2. Radiograph of a 38-year-old female patient with no compression fracture.

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