Escore de osso trabecular como método de avaliação da qualidade óssea em pacientes com síndrome de cushing

Abstract

Introduction: Cushing’s Syndrome is caused by glucocorticoids’ excess and may lead patients to adverse impacts in various systems, including the osteometabolic system, with a significant impact on their quality of life and work capacity. Objective: to analyze trabecular bone score (TBS), bone mineral density (BMD) and body composition by densitometry in patients with Cushing's Syndrome, comparing them with that of a control group. Patients and methods: a cross-sectional outpatient-based study was conducted with 40 individuals included, 20 from the Cushing's Syndrome group and 20 from the control group, who underwent densitometry with analysis of BMD, TBS and body composition.Clinical factors associated with fractures were evaluated and the risk of fracture was calculated using FRAX, with BMD, with and without adjustment by TBS. The study was approved by the ethics committee of the Universidade Federal de Minas Gerais (CAAE: 44915221.2.0000.5149). Results: population was mostly female (85%), with an average age of 42 years. 80% of the patients with Cushing’s Syndrome presented Cushing’s Desease. There was no difference between the groups regarding body mass index, age, sex and menopausal status. There was a higher prevalence of type 2 diabetes mellitus in the Cushing's group than in the Control group (p = 0.001). There was a trend towards a lower TBS in patients with Cushing's Syndrome (1.285 ± 0.149) than in Controls (1.362 ± 0.120; p= 0.081), in addition to a higher frequency of degraded TBS in patients with Cushing's Syndrome (25%) than in controls (10%). Patients with Cushing's Syndrome had lower BMD, T-score and Z-score in the lumbar spine and total body than controls (p = 0.001 for all comparisons). The 10-year fracture risk calculation by FRAX was similar between groups, even after adjustment for TBS. Conclusion: patients with Cushing's Syndrome showed lower BMD in the lumbar spine and total body than controls. TBS, despite having demonstrated a tendency towards reduction in patients with Cushing's Syndrome, did not prove to be more sensitive, in this study, than BMD. More studies, with a larger number of individuals, are needed to identify factors that predict fracture in these patients, allowing timely treatment, further avoiding this complication in individuals with Cushing's Syndrome.