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Bone and Mineral Metabolism

SUN-808 - Pathophysiology of Osteoporosis (PATHOS Study): Role of Occult Cortisol Excess and Its Predictive Factors in Skeletal Fragility

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor
Objective
To evaluate the prevalence of occult hypercortisolism (HidHyCo) in a cohort of patients with osteoporosis or osteopenia associated with comorbidities potentially related to cortisol excess, and to identify its predictive features.
Methods
A total of 1,382 patients without clinical signs of hypercortisolism or other secondary causes of osteoporosis were enrolled in five Italian centres. Inclusion criteria were osteoporosis and/or fragility fractures (FX), or osteopenia plus at least one of the following: arterial hypertension (AH) treated with ≥2 drugs, diabetes mellitus (DM), or cardiovascular (CV) events. Data on FX, DM, AH, dyslipidemia and CV events were collected. Bone mineral density (BMD) was assessed by DXA at the lumbar spine (LS), femoral neck (FN) and total hip (TH), and the presence of morphometric vertebral fractures (mFX) was evaluated. All patients underwent the 1-mg overnight dexamethasone suppression test (1mgDST) to screen for HidHyCo (cortisol cut-off ≥1.8 µg/dL).
Results
HidHyCo was diagnosed in 107 patients (7.7%). Compared with controls, the HidHyCo group was older (66.8±7.0 vs 63.2±7.6 years, p< 0.001) and had lower BMD (LS T-score -3.0±1.0 vs -2.8±1.0, p=0.035; FN -2.5±0.7 vs -2.3 ± 0.7, p=0.005; TH -2.1±0.7 vs -1.9±0.8, p=0.003). A higher prevalence of AH and AH treated with ≥2 drugs (52.1 vs 33.6%, p< 0.001; 19.1 vs 9.7%, p=0.004), dyslipidemia (62.4 vs 46.8%, p=0.004), FX (73.6 vs 52.2%, p< 0.001), major clinical FX (33.6 vs 18.9%, p< 0.001), clinical vertebral FX (70.8 vs 51.5%, p< 0.001), and mFX (37.1 vs 27.7%, p=0.040) was observed. At logistic regression analysis, the coexistence of FX and AH was independently associated with HidHyCo, after adjustment for age, sex, history of falls, smoking status, dyslipidemia, and DM (OR 2.3, 95% CI 1.4–4.0, p=0.002).
Conclusions
Occult hypercortisolism may be more prevalent than generally recognized in patients with skeletal fragility after exclusion of other secondary causes. The coexistence of fragility fractures and arterial hypertension identifies patients at higher risk of HidHyCo.

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