Faculty Collaboration Database

Bone Health in Patients With Adrenal Adenomas and Hypercortisolism: A Multicenter Cross-Sectional Study. Clin Endocrinol (Oxf) 2026 Feb;104(2):103-112

Date

10/08/2025

Pubmed ID

41058070

DOI

10.1111/cen.70048

Scopus ID

2-s2.0-105017902951 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

OBJECTIVE: Data on bone health in patients with mild autonomous cortisol secretion (MACS) are limited and heterogenous. We sought to assess the prevalence of osteoporosis and symptomatic fragility fractures in patients with adrenal adenomas and hypercortisolism, and explore associations with the degree of cortisol excess and frailty.

DESIGN: This multicenter cross -sectional study involved prospective enrollment of adults with nonfunctioning adrenal adenomas (NFA), MACS, Cushing syndrome (CS) and referent subjects without adrenal disorders during the study period (January 2019-September 2022). All participants completed a bone health questionnaire at enrollment and had dual-energy X-ray absorptiometry bone mineral density assessment within 12-months. Final analyses were adjusted for age, sex, body mass index, smoking status, alcohol use.

RESULTS: Participants included 117 with NFA (median age 62 years, 80% women), 191 with MACS (median age 63 years, 74% women), 62 with CS (median age 50 years, 92% women), and 101 referent subjects (median age 59 years, 47% women). Both patients with CS (OR: 3.0, 95% CI: 1.1-8.3) and MACS (OR: 2.2, 95% CI: 1.9-4.9) had a higher prevalence of osteoporosis when compared to referents. Among patients with MACS, only those with post 1-mg dexamethasone suppression test (post-1mg-DST) cortisol > 83 nmol/L had a higher prevalence of osteoporosis when compared to referents (OR: 3.2, 95% CI: 1.4-7.5) and NFA (OR: 2.2, 95% CI: 1.1-4.4). For clinical fragility fractures, only patients with CS showed an increased prevalence when compared to referents (OR: 6.1, 95% CI: 1.7-26.4) and NFA (OR: 3.8, 95% CI: 1.3-11.2). Prevalence of clinical fragility fractures was similar to referents in patients with MACS (OR: 1.8, 95% CI: 0.6-6.9) and NFA (OR: 1.5, 95% CI: 0.4-6.1), and was not associated with post-1mg-DST cortisol or frailty in the MACS and NFA groups.

CONCLUSION: Patients with CS, and those with MACS and post-1mg-DST cortisol > 83 nmol/L, exhibited a higher burden of osteoporosis. However, only CS was associated with an elevated risk of symptomatic fragility fractures.

Author List

Dogra P, Šambula L, Saini J, Drake MT, Athimulam S, Tsagarakis S, Vassiliadi DA, Antonopoulou V, Nathani R, Zhang CD, Genere N, Ambroziak U, Hubska J, Garcia RG, Bassiony M, Salama BH, Atkinson EJ, Fell V, Kastelan D, Larson JJ, Bancos I

Author

Catherine Zhang MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Absorptiometry, Photon
Adrenal Gland Neoplasms
Adrenocortical Adenoma
Adult
Aged
Bone Density
Cross-Sectional Studies
Cushing Syndrome
Female
Humans
Hydrocortisone
Male
Middle Aged
Osteoporosis
Prevalence
Prospective Studies