Table 8.

Adrenal (cortisol excess assays) evaluations in patients diagnosed with osteoporosis and fractures [83,84].

First Author Publication Year Reference Number Study Design	Studied Population Gender (F/M) Age (Years)	Criteria for ACS Diagnosis	Prevalence of ACS	DXA–BMD, T-Score or Z-Score	Fracture Prevalence
Chiodini 2007 [83] Cross-sectional study	N = 219 N1 = 147 with osteoporosis F/M = 131/16 Mean age: 63.7 y N2 = 72 without osteoporosis F/M = 69/3 Mean age: 57.4 y	Serum cortisol after LDDST > 50.0 nmol/L UFC > 165.6 nmol/L and/or midnight cortisol > 207 nmol/L	Prevalence of SH: N1–4.8% (1.32%−8.20%) N2:0% (p = 0.099)	N1: Mean T-score (SD) LS = −2.88 (1.08) FT = −1.96 (0.88) FN = −2.03 (0.88) N2: Mean T-score (SD) LS = −1.37 (1.09) FT = −0.99 (0.97) FN = −1.13 (0.90)	N1: Grade of fracture (I/II/III), N = 54/14/8 N2: Grade of fracture (I/II/III), N = 0
Pugliese 2021 [84] Cross-sectional study	N = 101 patients with fractures N1 = 5 with less severe hypercortisolism (LSH) F/M = 3/2 Mean age: 62.6 ± 13.3 y N2 = 96 with non-LSH patients F/M = 72/24 Mean age: 65 ± 10.3 y	Serum cortisol after 1 mg DST > 1.8 μg/dL for confirmation Serum cortisol after LDDST > 1.8 μg/dL	Prevalence of LSH: 5.0%	N1: LS BMD (Z-score) = −1.5 ± 1.1 SD FN BMD (Z-score)= −1.2 ± 0.6 SD N2: LS BMD (Z-score) = −1.5 ± 1.3 SD FN BMD (Z-score) = −0.9 ± 0.9 SD p = NS	All

Abbreviations: BMD = bone mineral density; DST = dexamethasone suppression test; F = female; FN = femoral neck; FT = total femur; LDDST = low-dose dexamethasone suppression test; LS = lumbar spine; LSH = less severe hypercortisolism; M = male; N = number of patients; NS = not significant; SD = standard deviation; SH = subclinical hypercortisolism; UFC = Urinary free cortisol; y = years.