Osteopathy in mild adrenal Cushing's syndrome and Cushing disease. Issue 2 (March 2021)

• Record Type: Journal Article
• Authors: Frara, Stefano; Allora, Agnese; di Filippo, Luigi; Formenti, Anna Maria; Loli, Paola; Polizzi, Elisabetta; Tradati, Daniele; Ulivieri, Fabio Massimo; Giustina, Andrea
• Is Part Of: Best practice & research. Volume 35:Issue 2(2021)
• Publication Date: 2021-03
• Subjects: bone mineral density -- fractures -- glucocorticoids -- bone quality -- cushing disease -- adrenal incidentaloma; Endocrine glands -- Diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; Endocrinology -- Periodicals; Metabolism -- Periodicals; 616.4
• DOI: 10.1016/j.beem.2021.101515
• Languages: English
• ISSNs: 1521-690X

Abstract

Abstract : Pathophysiology and effects of endogenous glucocorticoid (GC) excess on skeletal endpoints as well as awareness and management of bone fragility are reviewed. Cushing's syndrome (CS) increase the risk of fracture affecting prevalently bone quality. Bone antiresorptive agents (SERMs, bisphosphonates and denosumab) as well as teriparatide increase bone mineral density and in some instances reduce fracture risk. Awareness and management of bone health in CS can be improved. Highlights: Endogenous hypercortisolism increases fractures particularly at vertebral level mainly via negative impact on bone quality. Increase in skeletal fragility is reported in Cushing disease but also in mild forms of adrenal hypercortisolism. Vertebral morphometry is an emerging useful tool in the assessment of bone health in pituitary and adrenal Cushing forms. Bone health can improve after control/cure of hypercortisolism although normalization may occur only in the long-term. In endogenous Cushing awareness, diagnosis, prevention/treatment of bone damage represent a clinical need and good clinical practice.