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Bone involvement in aldosteronism.

[adrenal incidentaloma]

In rats with aldosteronism, a reduction of bone mineral density (BMD) and cortical bone strength has been reported. Our study was aimed to evaluate bone involvement in patients with primary aldosteronism (PA). A total of 188 consecutive subjects with adrenal incidentaloma, observed between November 2009 and October 2011, were screened for PA with aldosterone-to-renin ratio. After confirmatory tests, in those who screened positive, 11 patients were diagnosed as PA and 15 patients were not (nPA). A serum/urinary biochemical profile, parathyroid hormone (PTH), BMD measured at lumbar spine (LS) and total and femoral neck (TN and FN) by dual X-ray absorptiometry, and conventional spinal radiographs (T(4) -L(4) ) were obtained in all subjects. PA patients had a significantly higher 24-hour urinary calcium (6.28±1.85 versus 4.28±1.18mmol/d; p<0.01), and PTH (9.8 [5.8-14.6], median [range] versus 5.3 [2.5-10.8] pmol/L; p<0.01) than nPA patients. BMD expressed as Z-value at LS (-1.18±0.99 versus 0.22±1.12), FN (-0.85±0.73 versus 0.01±0.82), and TN (-0.49±0.61 versus 0.39±0.93) was lower in PA than in nPA (p=0.003, p=0.011, and p=0.012, respectively). The prevalence of osteoporosis was higher in PA than in nPA (8/11, 72.7% versus 3/15, 20.0%; Fisher's exact test: p=0.015). Vertebral fractures tended to be more prevalent in PA than in nPA (5/11, 45.5% versus 2/15, 13.3%; Fisher's exact test: p=0.095). Logistic regression analysis showed that osteoporosis and morphometric vertebral fractures were associated with PA (odds ratio [OR], 15.4; 95% confidence interval [CI]=1.83-130, p=0.012; and OR, 30.4; 95%CI, 1.07-862, p=0.045, respectively) regardless of age, body mass index (BMI), and LS-BMD. In 9 of 11 PA patients, 6 months after beginning of treatment (surgery or spironolactone) there was a significant reduction of urinary calcium excretion (p<0.01) and PTH (p<0.01), whereas in 5 of 11 PA patients, 1 year after beginning of treatment, BMD was significantly increased at LS, p<0.01). In conclusion, PA is associated with osteoporosis, vertebral fractures, and increased urinary calcium excretion.