Researchers have identified an additional deleterious effect of glucocorticoid therapy in women treated for Cushing’s syndrome.
Duration of both endogenous hypercortisolism and more importantly exogenous glucocorticoid replacement therapy after successful surgery negatively affect bone mass," Maria-José Barahona, MD, of the department of endocrinology at the Hospital Mútua de Terrassa, told Endocrine Today.
Because patients in remission after successful treatment of Cushing’s syndrome often present with hypoadrenalism and require long-term glucocorticoid replacement therapy, researchers set out to assess whether glucocorticoid replacement had any further effect on bone after long-term remission of Cushing’s syndrome.
The study included 37 women at a mean age of 50 with cured Cushing’s syndrome (mean time of cure: 11 years), 14 women with active Cushing’s syndrome and 85 sex-, BMI- and age-matched controls.
Data indicated that women with cured and active Cushing’s syndrome who were estrogen sufficient had less bone mineral content, bone mineral density and osteocalcin when compared with the control group (P<.01). These differences were not observed in estrogen-deficient women.
Further, the duration of glucocorticoid replacement therapy (mean duration: 42 months) and endogenous hypercortisolism therapy (mean duration: 70 months) were negatively associated with bone mineral content and lumbar spine BMD.
"Duration of endogenous hypercortisolism and glucocorticoid replacement therapy required after successful surgery should be decreased as much as possible," Barahona said. "An early diagnosis of Cushing's syndrome and surgery, and regular assessment of the recovery of the adrenal axis function are highly recommended."
The duration of glucocorticoid replacement therapy was the main predictor for abnormal bone mineral content and BMD (P<.01).
"Bone mass and bone mineral density should be assessed at diagnosis of Cushing's syndrome and during follow-up. We suggest considering starting treatment with bisphosphonates as soon as low bone mass is confirmed, since a more rapid improvement in bone mass has been reported with alendronate in cured Cushing's syndrome.” - by Jennifer Southall
Barahona MJ. J Bone Miner Res. 2009;24:1841-1846.