Patients with Endogenous Cushing's Syndrome. 21. Chapter 7. A Clinical Case of Pregnancy in a Patient. Treated with Ibandronic Acid 3.0 Intravenously. 23.
ENDOCRINOLOGY RESEARCH AND CLINICAL DEVELOPMENTS
GLUCOCORTICOID-INDUCED OSTEOPOROSIS FRACTURES AND BONE REMODELING IN PATIENTS WITH ENDOGENOUS CUSHING'S SYNDROME
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ENDOCRINOLOGY RESEARCH AND CLINICAL DEVELOPMENTS
GLUCOCORTICOID-INDUCED OSTEOPOROSIS FRACTURES AND BONE REMODELING IN PATIENTS WITH ENDOGENOUS CUSHING'S SYNDROME ZHANNA E. BELAYA LIUDMILA Y. ROZHINSKAYA ALEXANDER G. SOLODOVNIKOV NATALIA V. DRAGUNOVA AND GALINA A. MELNICHENKO
New York
Copyright © 2013 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com
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Library of Congress Cataloging-in-Publication Data ISBN: 978-1-62948-341-2
Published by Nova Science Publishers, Inc. † New York
Contents vii
Preface Chapter 1
Introduction
1
Chapter 2
The Prevalence of Low Traumatic Fractures among Patients with Endogenous Cushing’s Syndrome
3
Chapter 3
Chapter 4 Chapter 5 Chapter 6
Chapter 7
The Influence of a Mild Disruption of the Cortisol Level on Bone in Patients with Adrenal Incidentaloma
11
Pathogenesis of Glucocorticoid-Induced Osteoporosis
13
The Restoration of Bone after the Remission of Cushing’s Syndrome
19
The Possibility of Pharmacotherapy of Glucocorticoid-Induced Osteoporosis in Patients with Endogenous Cushing’s Syndrome
21
A Clinical Case of Pregnancy in a Patient Treated with Ibandronic Acid 3.0 Intravenously
23
Conclusion
27
Acknowledgments
29
References
31
Index
43
Preface This work is primarily focused on data related to the characteristics, pathogenesis and treatment of bone complications in patients with endogenous Cushing’s syndrome (CS) of various etiologies. The chapter is based on the retrospective and prospective data of patients with active CS as well as on literature review. We paid special attention to discussing pregnancy and bisphosphonate (BP) use, outlining the clinical case of a successful pregnancy in a patient treated with ibandronic acid (Bonviva). Materials and methods: Two hundred and twenty three patients with proven CS were interviewed on their recent low traumatic fractures. A thoracic and lumbar X-ray was performed to reveal vertebral fractures. Bone mineral density (BMD) was measured by DXA (Lunar). The level of free urinary cortisol (24h UFC) was measured by an immunochemiluminescence assay (extraction with diethyl ether) on a Vitros ECi. Late-night serum cortisol and markers of bone remodeling were assayed by electrochemiluminescence (ECLIA) Cobas e601 Roche. The other parameters were measured using commercially available assays. Results: among 223 patients with active CS, low traumatic fractures were confirmed in 43%; in most cases there were multiple fractures of the vertebras. BMD loss was mild. Patients with fractures statistically significantly differed in terms of sex (men fractured more frequently than women), had lower osteocalcin (OC) and higher 24hUFC as well as latenight serum cortisol. After regression analysis, the main predictors of low-traumatic fracture occurrence was 24h UFC (p
