Trabecular bone score (TBS) in Cushing's disease: TBS gain after hypercortisolism normalization

Area of Science:

• Endocrinology
• Bone Metabolism
• Osteoporosis Research

Background:

• Hypercortisolism from Cushing's disease (CD) commonly causes osteoporosis and increases fracture risk.
• Bone mass recovery is observed in CD patients post-treatment, but microarchitectural changes require further investigation.

Purpose of the Study:

• To evaluate the impact of Cushing's disease treatment on trabecular bone score (TBS) and areal bone mineral density (aBMD).
• To assess changes in bone microarchitecture using TBS in CD patients after successful treatment.

Main Methods:

• A single-center retrospective longitudinal study included 31 biochemically controlled CD patients.
• Trabecular bone score (TBS) and areal bone mineral density (aBMD) were measured before and after treatment using DXA and TBS iNsight®.
• Patient data included age, BMI, and 24-hour urinary cortisol levels.

Main Results:

• Significant improvements in both TBS (+8.2%) and aBMD (+3.9%) were observed after cure of CD (p < 0.0001 and p < 0.001).
• TBS and aBMD were not correlated before or after treatment.
• TBS gain was independent of baseline BMI, and low baseline TBS predicted greater TBS gain.

Conclusions:

• Trabecular bone score (TBS) demonstrates a more substantial improvement than aBMD after Cushing's disease cure, suggesting it's a sensitive marker of bone restoration.
• TBS may offer a more accurate assessment of bone microarchitectural recovery compared to aBMD in treated CD patients.
• Further research with larger cohorts and longer follow-up is recommended to confirm these findings.