Undiagnosed Primary Aldosteronism: a New Cause of Secondary Osteoporosis

Presentation Number: SUN 309
Date of Presentation: April 2nd, 2017

Antonio Stefano Salcuni*1, Vincenzo Carnevale1, Claudia Battista2, Serena Palmieri3, Cristina Eller-Vainicher3, Flavia Pugliese1, Vito Guarnieri1, Giuseppe Guglielmi1, Gaetano Desina1, Salvatore Minisola4, Iacopo Chiodini5 and Alfredo Scillitani6
1‘‘Casa Sollievo della Sofferenza,’’ IRCCS, San Giovanni Rotondo, 2‘‘Casa Sollievo della Sofferenza,’’ IRCCS, 3University of Milan, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy, 4Department of Internal Medicine and Medical Disciplines "Sapienza" Rome University, Rome, Italy, Rome, Italy, 5Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milano, 6‘‘Casa Sollievo della Sofferenza,’’ IRCCS, San Giovanni Rotondo, Italy

Abstract

The involvement of mineralocorticoids on bone metabolism has been reported. Indeed, patients with primary aldosteronism (PA) have a high prevalence of osteoporosis (OP) and fractures (Fx). The objective of our study was to prospectively evaluate the prevalence of subclinical PA in patients admitted to our metabolic bone disease outpatient clinic. This was a prospective, multicenter study. The study was conducted on an in- and outpatient basis in two referral Italian endocrinology units. A total of 2362 patients were included in the study. Among them, 2317 were excluded because they were taking drugs known to affect bone or mineralocorticoids metabolism, were hypokaliemic or were diagnosed to have a secondary cause of osteoporosis. The remaining 315 subjects (299 females, 16 males) took part in the study. Bone mineral density (BMD) and thoracic and lumbar spine vertebral morphometry were performed by dual X-ray absorptiometry. All patients were screened for PA with aldosterone-to-renin ratio. Those who screened positive, confirmatory tests were performed. Among 315 subjects, 207 were osteoporotics and 108 were not. Subclinical PA was diagnosed in ten out of 207 osteoporotic patients (4.8%) and one out of 108 non osteoporotic subjects (0.9%, p= 0.072). PA was observed in the 23.8% of patients with the concomitant presence of osteoporosis, hypertension and hypercalciuria. Compared with patients without PA, patients with subclinical PA had mean values of urinary calcium excretion, 194 ± 101 mg/day (4.8 ± 2.5 mmol/day) vs 296 ± 125 mg/day (7.3 ± 3.1 mmol/day), respectively, p<0.001 and serum PTH levels, 50.1 (5.4 pmol/L) vs 65 pg/ml (7.0 pmol/L), respectively, p <0.05 significantly higher. This study suggests that PA should be considered among the causes of secondary OP. 

 

Nothing to Disclose: ASS, VC, CB, SP, CE, FP, VG, GG, GD, SM, IC, AS