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Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how?

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Abstract

Guidelines for the management of osteoporosis induced by endogenous hypercortisolism are not available. Both the American College of Rheumatology and the International Osteoporosis Foundation recommend to modulate the treatment of exogenous glucocorticoid-induced osteoporosis (GIO) based on the individual fracture risk profile (calculated by FRAX) and dose of glucocorticoid used, but it is difficult to translate corticosteroid dosages to different degrees of endogenous hypercortisolism, and there are no data on validation of FRAX stratification method in patients with endogenous hypercortisolism. Consequently, it is unclear whether such recommendations may be adapted to patients with endogenous hypercortisolism. Moreover, patients with exogenous GIO take glucocorticoids since suffering a disease that commonly affects bone. On the other hand, the correction of coexistent risk factors, which may contribute to increase the fracture risk in patients exposed to glucocorticoid excess, and the removal of the cause of endogenous hypercortisolism, may lead to the recovery of bone health. Although the correction of hypercortisolism and of possible coexistent risk factors is necessary to favor the normalization of bone turnover with recovery of bone mass; in some patients, the fracture risk could not be normalized and specific anti-osteoporotic drugs should be given. Who, when, and how the patient with endogenous hypercortisolism should be treated with bone-active therapy is discussed.

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Authors and Affiliations

  1. Unit of Endocrinology, “Casa Sollievo della Sofferenza” Hospital, 71013, San Giovanni Rotondo, Italy

    A. Scillitani

  2. Department of Medicine, Endocrine and Bone Unit, Carlo Poma Hospital, 46100, Mantua, Italy

    G. Mazziotti

  3. SDN IRCCS Foundation, Naples, Italy

    C. Di Somma

  4. Endocrinology Unit, Department of Internal Medicine and Medical Specialties & Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genoa, Italy

    S. Moretti

  5. Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189, Rome, Italy

    A. Stigliano

  6. Chair of Endocrinology, University of Brescia, Brescia, Italy

    A. Giustina

  7. Department of Clinical Medicine and Surgery, Section of Endocrinology, Federico II University, Naples, Italy

    R. Pivonello & A. Colao

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  1. A. Scillitani
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Correspondence to A. Scillitani.

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ABC (Altogether to Beat Cushing’s syndrome) 2012 Group: N. Albiger, A. Ambrogio, G. Arnaldi, E. Arvat, R. Baldelli, R. Berardelli, M. Boscaro, S. Cannavò, F. Cavagnini, A. Colao, S.M. Corsello, A. Cozzolino, A. De Bartolomeis, M. De Leo, G. Di Minno, C. Di Somma, K. Esposito, G. Fabbrocini, D. Ferone, C. Foresta, M. Galderisi, C. Giordano, D. Giugliano, A. Giustina, F. Grimaldi, A.M. Isidori, E. Jannini, F. Lombardo, L. Manetti, M. Mannelli, F. Mantero, G. Marone, G. Mazziotti, S. Moretti, E. Nazzari, R.M. Paragliola, R. Pasquali, S. Pecorelli, F. Pecori Giraldi, C. Pivonello, R. Pivonello, G. Reimondo, C. Scaroni, A. Scillitani, C. Simeoli, A. Stigliano, V. Toscano, L. Trementino, G. Vitale, M.C. Zatelli.

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Scillitani, A., Mazziotti, G., Di Somma, C. et al. Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how?. Osteoporos Int 25, 441–446 (2014). https://doi.org/10.1007/s00198-013-2588-y

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  • DOI: https://doi.org/10.1007/s00198-013-2588-y

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