Fracture risk and bone health in adrenal adenomas with mild autonomous cortisol secretion/subclinical hypercortisolism: a systematic review, meta-analysis and meta-regression
Authors' conclusion
To conclude, people with adrenal adenomas/incidentalomas and MACS/SH are at a 1.5- to 2-fold higher likelihood of fractures and osteoporosis/osteopenia compared to non-functional adrenal adenomas
Study context
- Population
- Patients with adrenal adenomas/incidentalomas; observational studies from PubMed/MEDLINE, Embase and Web of Science16 observational studies
- Comparison
- Mild autonomous cortisol secretion (MACS)/subclinical hypercortisolism (SH) vs non-functional adrenal adenomas
- Outcome
- Pooled prevalence of fractures, osteoporosis/osteopenia in MACS/SH and comparison with non-functional adenomas
Methodological detailsmeta-regression, observational studies
- Meta-regression
- Observational studies
Pooled result
As reported in the abstract
Pooled prevalence in MACS/SH
Any fractures (vertebral and non-vertebral), MACS/SH
43%
95% CI 23%, 62%
Vertebral fractures, MACS/SH
45%
95% CI 22%, 68%
Osteoporosis/osteopenia, MACS/SH
50%
95% CI 33%, 66%
Further pooled results
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Any fractures | 1.61 (1.18–2.20) | P = 0.0026 | |
| Vertebral fractures | 2.10 (1.28–3.45) | P = 0.0035 | |
| Osteoporosis/osteopenia | 1.46 (1.15–1.85) | P = 0.0018 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | MD (g/cm²) (95% CI) | P value | |
|---|---|---|---|
| Lumbar spine BMD | −0.07 (−0.11 to −0.03) | P = 0.0004 | |
| Femoral neck BMDPublication bias in pooled MD of femoral neck BMD | −0.05 (−0.08 to −0.02) | P = 0.0045 | |
| −0.15−0.1−0.0500.05Difference, g/cm² (linear scale) |
Predictors of fracture risk (meta-regression)
- Age, sex, 24-hour UFC and DHEAS did not predict fracture risk
BTMs
- Limited data showed no significant difference in BTMs
Original publication
Fracture risk and bone health in adrenal adenomas with mild autonomous cortisol secretion/subclinical hypercortisolism: a systematic review, meta-analysis and meta-regression. J Bone Miner Res. Published 4 May 2024. doi:10.
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