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Master Thesis

Évaluation du retentissement osseux de la maladie de Cushing par l'outil Trabecular Bone Score

Abstract : Rational : Rare studies conducted in patients with Cushing’s disease (CD), a model of endogenous hypercortisolism, have pinpointed dissociation between the increased risk of fracture and apparently normal Bone Mineral Density (BMD). The Trabecular Bone Score (TBS), a new and non-invasive texture measurement extracted from spine Dual-Energy X-ray Absorptiometry (DXA), has been proposed as an index of bone microarchitecture. The aim of this study was to evaluate the bone impact of CD assessed by TBS and aBMD, at various status. Methods : In a monocentre restrospective study, patients with CD (ACTH-dependent hypercortisolism associated with an ACTH-secreting pituitary adenoma or petrosal sinus sampling dosages) who underwent a DXA evaluation, from 2006 to 2014 were recruited. In a cross-sectional study, TBS (at lumbar spine) and aBMD (at total femoral neck and lumbar spine) were evaluated and compared to normative data (age and sex-matched : Z-scores). Clinical data, endocrinological data, osteoporotic fractures, disease status (Hypercortisolism : HY, Eucortisolism : EU, and corticotrope insufficiency with hydrocortisone supplementation : CIH) have been reported. The change of TBS and aBMD after surgery treatment were also evaluated in a longitudinal study. Results : We recruited 55 patients with CD (44 women, age and BMI: 50.8 ± 15.8 years and 27.3 ± 5.2 kg/m²). Compared with the normal values for age, CD subjects had lower TBS value (Z-score = -0.8 ± 1.3 SD ; p<0.001) whereas no difference was found for spine aBMD (Z-score = 0.3 ± 1.5 SD ; p >0,49) or at total femur (Z-score = 0 ± 1,1 ; p=0,95). Patients with HY had a significant reduction TBS compared to normal values (Z-score = -1,3 ± 1,1 SD ; p<0,001) and to EU-patients (Z-score = -0,2 ± 1,2 SD ; p<0,05), despite a positive spine aBMD Z-score (= 0,3 ± 1,5 SD ; p>0,05 for HY). CIH-subjects had lower TBS than EU (Z-score = -0,7 ± 1,6 SD ; p>0,05). Men with HY had lower TBS values than women with HY (TBS = 1,105 vs. 1,244 ; p<0,01). Subjects with fractures (n=16) had lower Z-score TBS than subjects less fractures (n=39) (-1,2 ±1,1 SD vs. -0,7 ±1,3 SD; p=0,24) whereas spine and femur Z-scores aBMD was higher in group with fractures (p>0,05 for both). Finally, we obt! ained, in 9 patients (longitudinal study), an improvement TBS after surgery (10 months after) greater than spine and femur aBMD (Δ Z-score TBS = 0,038, Δ Z-score spine aBMD = 0,015, Δ Z-score femur aBMD = 0,007; p> 0,13 for all). Conclusion: A specific bone pattern exists in CD subjects consisting in a marked alteration of the trabecular texture assessed by TBS despite a normal aBMD. This alteration seems to be gender related with a higher impairment in men. One striking findings of this study is that a specific bone pattern exists for each CD status and activity, and that CIH subjects, usually considered in remission, have also a bone pattern alteration. Moreover, patients with fractures had a lower TBS score than others but higher BMD-spine score. These results suggest that bone microarchitectural texture alteration, as assessed by TBS, should be taken into account in order to manage patient with CD.
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Master Thesis
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Submitted on : Monday, June 22, 2015 - 3:16:01 PM
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Amandine Boisson. Évaluation du retentissement osseux de la maladie de Cushing par l'outil Trabecular Bone Score. Médecine humaine et pathologie. 2015. ⟨dumas-01166307⟩

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