Subclinical hypercortisol-assessment of bone fragility: experience of single osteoporosis center in Sicily

AIM: Hypercortisolism is known to cause osteoporosis. Some evidence suggests that osteoporotic fractures may be the present- ing manifestations of otherwise-asymptomatic hypercortisolism. The aim of our research was to investigate the prevalence of subclinical hyper- cortisolism (SH) in postmenopausal women evaluated for bone fragility PATIENTS AND METHODS: One hundred con- secutive postmenopausal women attending the Osteoporosis Centre in the Department of Inter- nal Medicine of the University of Messina (Messina, Italy), for the first time, were screened and a total of 50 patients (age 58±5 years) were studied. Hypercortisolism was assessed with unsuppressed serum cortisol levels after 2 day low dose dexamethasone suppression test. RESULTS: Of the 50 postmenopausal women studied, 3 had SH. This prevalence was 6%. The three patients with SH had a normal bone miner- al density (BMD) at lumbar spine and were os- teopenic at femoral neck, and presented one or more vertebral fractures at spinal radiography. CONCLUSIONS: Physicians should always consider SH among the causes of bone fragility, especially in individuals with vertebral fractures and the presence of an only slightly reduced BMD.