{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:26Z","timestamp":1787004866115,"version":"build-2736575974"},"reference-count":42,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Mild autonomous cortisol secretion (MACS) has thus far been associated with\n                    several comorbidities, among which osteoporosis and fractures appear to be\n                    highly prevalent. Recent guidelines for adrenal incidentalomas have updated the\n                    definition of MACS, currently formulated on serum cortisol after a 1-mg\n                    dexamethasone test above 1.8\u2009\u00b5g\/dL or 50 nmol\/L. Previous studies on bone health\n                    in adrenal incidentalomas had adopted different definitions of MACS, producing\n                    heterogeneous results in terms of fracture prevalence. This review aims to\n                    summarize the clinical impact of MACS in relation to fractures, bone quantity\n                    and quality, by providing a thorough update on MACS-related osteoporosis\n                    (MACS-ROP). This area has a large room for research, and management of this\n                    comorbidity still needs to be elucidated.<\/jats:p>","DOI":"10.1055\/a-2329-5787","type":"journal-article","created":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T19:27:25Z","timestamp":1715974045000},"page":"712-722","source":"Crossref","is-referenced-by-count":14,"title":["Mild Autonomous Cortisol Secretion (MACS) \u2013 Related\n                    Osteoporosis"],"prefix":"10.1055","volume":"132","author":[{"given":"Guido","family":"Zavatta","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes Prevention and Care, IRCCS\n                    Azienda Ospedaliero-Universitaria di Bologna"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater\n                    Studiorum University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Di Dalmazi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes Prevention and Care, IRCCS\n                    Azienda Ospedaliero-Universitaria di Bologna"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater\n                    Studiorum University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,12,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1093\/ejendo\/lvad066","article-title":"European Society of Endocrinology clinical practice guidelines on the management\n                    of adrenal incidentalomas, in collaboration with the European Network for the\n                    Study of Adrenal Tumors","volume":"189","author":"M Fassnacht","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"European Society of Endocrinology Clinical Practice Guideline in collaboration\n                    with the European Network for the Study of Adrenal Tumors","volume":"175","author":"M Fassnacht","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1093\/ejendo\/lvad038","article-title":"Mild autonomous cortisol secretion in adrenal incidentalomas and risk of\n                    fragility fractures: A large cross-sectional study","volume":"188","author":"G Zavatta","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"e623","DOI":"10.1210\/clinem\/dgad560","article-title":"Increased risk of vertebral fractures in patients with mild autonomous cortisol\n                    secretion","volume":"109","author":"V Favero","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1038\/s41574-020-0341-0","article-title":"Pathogenesis of glucocorticoid-induced osteoporosis and options for\n                    treatment","volume":"16","author":"P Chotiyarnwong","year":"2020","journal-title":"Nat Rev Endocrinol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s00198-010-1524-7","article-title":"Guidance for the adjustment of FRAX according to the dose of\n                    glucocorticoids","volume":"22","author":"J A Kanis","year":"2011","journal-title":"Osteoporos Int"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"R265","DOI":"10.1530\/EJE-16-0289","article-title":"Mechanisms in endocrinology: Endogenous subclinical hypercortisolism and bone: A\n                    clinical review","volume":"175","author":"I Chiodini","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1359\/jbmr.2002.17.6.979","article-title":"Osteoblastic 11beta-hydroxysteroid dehydrogenase type 1 activity increases with\n                    age and glucocorticoid exposure","volume":"17","author":"M S Cooper","year":"2002","journal-title":"J Bone Miner Res"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1172\/JCI106610","article-title":"Effect of cortisone treatment on the active transport of calcium by the small\n                    intestine","volume":"50","author":"D V Kimberg","year":"1971","journal-title":"J Clin Invest"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1172\/JCI107304","article-title":"Effects of cortisone administration on the metabolism and localization of\n                    25-hydroxycholecalciferol in the rat","volume":"52","author":"M J Favus","year":"1973","journal-title":"J Clin Invest"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/0026-0495(83)90221-4","article-title":"Importance of increased urinary calcium excretion in the development of\n                    secondary hyperparathyroidism of patients under glucocorticoid therapy","volume":"32","author":"Y Suzuki","year":"1983","journal-title":"Metabolism"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s12020-016-1146-8","article-title":"Glucocorticoid-induced osteoporosis: pathophysiological role of GH\/IGF-I and\n                    PTH\/VITAMIN D axes, treatment options and guidelines","volume":"54","author":"G Mazziotti","year":"2016","journal-title":"Endocrine"},{"key":"ref13","first-page":"603","article-title":"Determinants of muscle function and health-related quality of life in patients\n                    with endogenous hypercortisolism: A cross-sectional study","volume":"188","author":"D Li","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.bone.2005.10.004","article-title":"Effects of dissociated glucocorticoids on OPG and RANKL in osteoblastic\n                    cells","volume":"38","author":"E L Humphrey","year":"2006","journal-title":"Bone"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ecl.2021.03.002","article-title":"Glucocorticoid- and transplantation-induced osteoporosis","volume":"50","author":"G Zavatta","year":"2021","journal-title":"Endocrinol Metab Clin North Am"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.ecl.2018.01.003","article-title":"Recent advances on subclinical hypercortisolism","volume":"47","author":"G Zavatta","year":"2018","journal-title":"Endocrinol Metab Clin North Am"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1210\/jc.2003-031413","article-title":"Spinal volumetric bone mineral density and vertebral fractures in female\n                    patients with adrenal incidentalomas: The effects of subclinical\n                    hypercortisolism and gonadal status","volume":"89","author":"I Chiodini","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1530\/EJE-07-0137","article-title":"Effects of sex steroids on bone in women with subclinical or overt endogenous\n                    hypercortisolism","volume":"157","author":"L Tauchmanov\u00e0","year":"2007","journal-title":"Eur J Endocrinol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"3207","DOI":"10.1210\/jc.2009-0468","article-title":"Bone mineral density, prevalence of vertebral fractures, and bone quality in\n                    patients with adrenal incidentalomas with and without subclinical\n                    hypercortisolism: An Italian multicenter study","volume":"94","author":"I Chiodini","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/j.1365-2265.2008.03310.x","article-title":"Eugonadal male patients with adrenal incidentalomas and subclinical\n                    hypercortisolism have increased rate of vertebral fractures","volume":"70","author":"I Chiodini","year":"2009","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/BF03346473","article-title":"Weekly clodronate treatment prevents bone loss and vertebral fractures in women\n                    with subclinical Cushing's syndrome","volume":"32","author":"L Tauchmanova","year":"2009","journal-title":"J Endocrinol Invest"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1002\/jbmr.398","article-title":"Risk of new vertebral fractures in patients with adrenal incidentaloma with and\n                    without subclinical hypercortisolism: A multicenter longitudinal study","volume":"26","author":"V Morelli","year":"2011","journal-title":"J Bone Miner Res"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1002\/jbmr.1648","article-title":"Bone quality, as measured by trabecular bone score in patients with adrenal\n                    incidentalomas with and without subclinical hypercortisolism","volume":"27","author":"C Eller-Vainicher","year":"2012","journal-title":"J Bone Miner Res"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1530\/EJE-12-0777","article-title":"Bilateral and unilateral adrenal incidentalomas: Biochemical and clinical\n                    characteristics","volume":"168","author":"V Morelli","year":"2013","journal-title":"Eur J Endocrinol"},{"key":"ref25","first-page":"352","article-title":"Subclinical hypercortisol-assessment of bone fragility: Experience of single\n                    osteoporosis center in Sicily","volume":"18","author":"A Lasco","year":"2014","journal-title":"Eur Rev Med Pharmacol Si"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1530\/EJE-15-0977","article-title":"Adrenalectomy reduces the risk of vertebral fractures in patients with\n                    monolateral adrenal incidentalomas and subclinical hypercortisolism","volume":"174","author":"A S Salcuni","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1007\/s00198-018-4608-4","article-title":"The association of cortisol and adrenal androgen with trabecular bone score in\n                    patients with adrenal incidentaloma with and without autonomous cortisol\n                    secretion","volume":"29","author":"B-J Kim","year":"2018","journal-title":"Osteoporos Int"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s00198-019-04871-5","article-title":"The effects of cortisol and adrenal androgen on bone mass in Asians with and\n                    without subclinical hypercortisolism","volume":"30","author":"S H Ahn","year":"2019","journal-title":"Osteoporos Int"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"e2726","DOI":"10.1210\/clinem\/dgaa263","article-title":"Bone evaluation by high-resolution peripheral quantitative computed tomography\n                    in patients with adrenal incidentaloma","volume":"105","author":"A B Moraes","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/cen.14385","article-title":"Association of urinary free cortisol with bone formation in patients with mild\n                    autonomous cortisol secretion","volume":"94","author":"A Ishida","year":"2021","journal-title":"Clin Endocrinol (Oxf.)"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1530\/EJE-20-1396","article-title":"Risk of bone fractures after the diagnosis of adrenal adenomas: A\n                    population-based cohort study","volume":"184","author":"D Li","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"ref32","first-page":"1","volume-title":"Sex difference in the association of osteoporosis and osteopenia prevalence in\n                    patients with adrenal adenoma and different degrees of cortisol excess. Borretta\n                    G, ed. Int J Endocrinol","author":"S Izawa","year":"2022"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1093\/ejendo\/lvad113","article-title":"High prevalence of frailty in patients with adrenal adenomas and adrenocortical\n                    hormone excess: A cross-sectional multi-centre study with prospective\n                    enrolment","volume":"189","author":"P Dogra","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S2213-8587(22)00100-0","article-title":"Age-dependent and sex-dependent disparity in mortality in patients with adrenal\n                    incidentalomas and autonomous cortisol secretion: An international,\n                    retrospective, cohort study","volume":"10","author":"T Deutschbein","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.bone.2018.05.026","article-title":"In which patients does lumbar spine trabecular bone score (TBS) have the largest\n                    effect?","volume":"113","author":"P Martineau","year":"2018","journal-title":"Bone"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/cen.13743","article-title":"Assessment of vertebral microarchitecture in overt and mild Cushing\u2019s syndrome\n                    using trabecular bone score","volume":"89","author":"H Vinolas","year":"2018","journal-title":"Clin Endocrinol (Oxf.)"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1210\/endrev\/bnac031","article-title":"Bone turnover markers: Basic biology to clinical applications","volume":"44","author":"M Schini","year":"2023","journal-title":"Endocr Rev"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1210\/clinem\/dgaa120","article-title":"The impact of mild autonomous cortisol secretion on bone turnover markers","volume":"105","author":"S Athimulam","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"dgaa048","DOI":"10.1210\/clinem\/dgaa048","article-title":"Pharmacological management of osteoporosis in postmenopausal women: An Endocrine\n                    Society Guideline pdate","volume":"105","author":"D Shoback","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"564","DOI":"10.4158\/GL-2020-0524","article-title":"American Association of Clinical Endocrinologists\/American College of\n                    Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of\n                    Postmenopausal Osteoporosis- 2020 update executive summary","volume":"26","author":"P M Camacho","year":"2020","journal-title":"Endocr Pract"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1002\/art.42646","article-title":"2022 American College of Rheumatology guideline for the prevention and treatment\n                    of glucocorticoid-induced osteoporosis","volume":"75","author":"M B Humphrey","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1002\/jbmr.4033","article-title":"The effect of biochemical remission on bone metabolism in Cushing's\n                    syndrome: A 2-year follow-up study","volume":"35","author":"L T Braun","year":"2020","journal-title":"J Bone Miner Res"}],"container-title":["Experimental and Clinical Endocrinology &amp; Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2329-5787.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T18:46:34Z","timestamp":1733942794000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2329-5787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,17]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,11]]},"published-print":{"date-parts":[[2024,12]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2329-5787","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5,17]]},"published":{"date-parts":[[2024,5,17]]}}}