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. 2021 Apr;184(4):597-606.
doi: 10.1530/EJE-20-1396.

Risk of bone fractures after the diagnosis of adrenal adenomas: a population-based cohort study

Dingfeng Li  1 , Ravinder Jeet Kaur  1 , Catherine D Zhang  1 , Andreas Ebbehoj  2 , Sumitabh Singh  1 , Elizabeth J Atkinson  3 , Sara J Achenbach  3 , Walter Rocca  4   5   6 , Sundeep Khosla  1 , Irina Bancos  1
Affiliations

Risk of bone fractures after the diagnosis of adrenal adenomas: a population-based cohort study

Dingfeng Li et al. Eur J Endocrinol. 2021 Apr.

Abstract

Objective: Several small studies reported increased prevalence and incidence of asymptomatic vertebral fractures in patients with non-functioning adrenal adenomas and adenomas with mild autonomous cortisol secretion. However, the risk of symptomatic fractures at vertebrae, and at other sites remains unknown. Our objective was to determine the prevalence and incidence of symptomatic site-specific fractures in patients with adrenal adenomas.

Design: Population-based cohort study, Olmsted County, Minnesota, USA, 1995-2017.

Methods: Participants were the patients with adrenal adenoma and age/sex-matched referent subjects. Patients with overt hormone excess were excluded. Main outcomes measures were prevalence and incidence of bone fractures.

Results: Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years (20-96). At the time of diagnosis, patients had a higher prevalence of previous fractures than referent subjects (any fracture: 47.9% vs 41.3%, P = 0.003, vertebral fracture: 6.4% vs 3.6%, P = 0.004, combined osteoporotic sites: 16.6% vs 13.3%, P = 0.04). Median duration of follow-up was 6.8 years (range: 0-21.9 years). After adjusting for age, sex, BMI, tobacco use, prior history of fracture, and common causes of secondary osteoporosis, patients with adenoma had hazard ratio of 1.27 (95% CI: 1.07-1.52) for developing a new fracture during follow up when compared to referent subjects.

Conclusions: Patients with adrenal adenomas have higher prevalence of fractures at the time of diagnosis and increased risk to develop new fractures when compared to referent subjects.

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Conflict of interest statement

Declaration of interest:

IB reports consulting with Corcept, CinCor, HRA Pharma, Strongbridge, Sparrow Pharmaceutics outside the submitted work.

Figures

Figure 1.
Figure 1.. Participant flow
A total of 1881 residents of Olmsted County were registered in Rochester Epidemiology Project with at least one diagnosis code of adrenal mass between 1995 and 2017. After review of medical records, we confirmed 1004 Olmsted County residents diagnosed with an asymptomatic adrenal adenoma between 1995 and 2017, and matched 1:1 for age and sex with 1004 referent subjects who resided in Olmsted County between 1995 and 2017.
Figure 2.
Figure 2.. Cumulative incidence of new bone fractures
A. Cumulative incidence of new bone fractures of any site in patients with adenoma versus referent subjects, starting at 6 months following the index date. After excluding participants who had fractures prior to this starting point, 483 patients with adrenal adenoma and 560 referent subjects entered the analysis. The numbers of participants who completed 5-, 10-, and 15-year passive follow-up period were shown in the figure. B. Cumulative incidence of new bone fractures of any site in patients with mild autonomous cortisol secretion (MACS), nonfunctioning adrenal tumors (NFAT), and adenomas with unknown cortisol secretion (AUCS), starting at 6 months following the index date. After excluding participants who had fractures prior to this starting point, 42 patients with MACS, 78 patients with NFAT, and 363 patients with AUCS entered the analysis. The numbers of participants who completed 5-, 10-, and 15-year passive follow-up period were shown in the figure. The curves have been adjusted by age and sex difference between each group.
See this image and copyright information in PMC

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