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As a consequence, even the indications for the evaluation of bone involvement in SH patients are debatable and guidelines are not available. Finally, the relative importance of bone density, bone quality and glucocorticoid sensitivity in SH is a recent field of research. On the other hand, SH prevalence seems to be increased in osteoporotic patients, in whom a vertebral fracture may be the presenting symptom of an otherwise asymptomatic cortisol excess. Therefore, the issue of who and how to screen for SH among the osteoporotic patients is widely debated. The present review will summarize the available data regarding the bone turnover, bone mineral density, bone quality and risk of fracture in patients with endogenous SH. In addition, the role of the individual glucocorticoid sensitivity in SH-related bone damage and the problem of diagnosing and managing the bone consequences of SH will be reviewed. Finally, the issue of suspecting and screening for SH patients with apparent primary osteoporosis will be addressed.<\/jats:p>","DOI":"10.1530\/eje-16-0289","type":"journal-article","created":{"date-parts":[[2016,7,14]],"date-time":"2016-07-14T00:56:11Z","timestamp":1468457771000},"page":"R265-R282","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":70,"title":["MECHANISMS IN ENDOCRINOLOGY: Endogenous subclinical hypercortisolism and bone: a clinical review"],"prefix":"10.1093","volume":"175","author":[{"given":"I","family":"Chiodini","sequence":"first","affiliation":[{"name":"1Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS C\u00e0 Granda-Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Eller","family":"Vainicher","sequence":"additional","affiliation":[{"name":"1Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS C\u00e0 Granda-Ospedale Maggiore 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