Risk Factors for Osteoporotic Vertebral Fracture in Cushing Syndrome

Seung-Hwan Lee; Byeong-Mun Park; Kyung-Sub Song; Su-Keon Lee; Sang-Phil Yoon; Chae-Chul Lee; Beom-Seok Lee; Bong-Seok Yang

doi:10.4184/jkss.2017.24.1.1

Journal List > J Korean Soc Spine Surg > v.24(1) > 1076127

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Lee, Park, Song, Lee, Yoon, Lee, Lee, and Yang: Risk Factors for Osteoporotic Vertebral Fracture in Cushing Syndrome

Original Article

Journal of Korean Spine Surg 2017;24(1):1-6.

Published online: 31 March 2017

DOI: https://doi.org/10.4184/jkss.2017.24.1.1

Risk Factors for Osteoporotic Vertebral Fracture in Cushing Syndrome

Seung-Hwan Lee, M.D., Byeong-Mun Park, M.D., Kyung-Sub Song, M.D., Su-Keon Lee, M.D., Sang-Phil Yoon, M.D., Chae-Chul Lee, M.D., Beom-Seok Lee, M.D., Bong-Seok Yang, M.D.

Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital

Corresponding author: Bong-Seok Yang, M.D. Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital #36, Gwangmyeong-si, Gyeonggi-do, 14241 Korea TEL: +82-2-2680-7699, FAX: +82-2-2680-7755 E-mail: faridat80@gmail.com

Received 3 February 201615 February 2016 Accepted 21 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Cushing syndrome, Vertebral fracture, Osteoporosis

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Fig. 1.

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

Fig. 2.

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

Table 1.

Descriptive data of patients

	Control group(24)	Vertebral fracture group(8)	p-value
Age (years)	54.46(±16.91)	58.13(±18.85)	0.609
Height (cm)	157.23(±3.82)	158.56(±10.97)	0.745
Weight (kg)	61.45(±8.37)	73.47(±12.12)	0.004
BMI^∗ (kg/m²)	24.93(±3.81)	29.54(±6.27)	0.018
L-BMD^† (T-score)	−1.08(±1.09)	−2.69(±1.89)	0.006
FN-BMD^‡ (T-score)	−0.94(±1.17)	−1.21(±1.51)	0.595
ACTH^§ (pg/ml)	15.02(±25.39)	13.54(±17.20)	0.880
UFC^\|\| (μg/dl)	289.37(±373.53)	147.88(±251.96)	0.329

^∗ Body mass index (BMI)

^† Lumbar spine bone mineral density (L-BMD)

^‡ Femoral neck bone mineral densiry (FN-BMD)

^§ Adrenocorticotropic hormone (ACTH)

^|| Uring free cortisol (UFC).

Table 2.

Factors influencing L-BMD by multivariate linear regression analysis

	ß	t	p-value
Gender	−0.242	−1.486	0.148
UFC	−0.296	−1.743	0.092
BMI	−0.442	−2.612	0.014

Table 3.

Odd ratios for vertebral fractures for risk factors by logistic regression analysis

	Odd ratio	P-value	95% CI
Male gender	10.06	0.172	0.37-276.57
Obesity	6.7	0.183	0.41-110.18
Osteoporosis	18.56	0.016	1.72-200.21
Menopause	5.52	0.453	0.64-480.08
UFC(1μg increase)	1	0.975	0.994-1.007

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