Clin Osteol 2008; 13(3): 84-90
Bone changes in patients with adrenal insufficiency (Addison's disease) treated with glucocorticoid replacement therapyOriginal contributions
Objective: The primary goal was to determine the effect of glucocorticoid replacement th lected parameters of calcium and phosphate (Ca-Ph) metabolism and selected bone markers.
Patients and methods: The group comprised 46 patients with Addison's disease (12 males, 17 pre- and 17 postmenopausal females). In all subjects, their basic parameters of Ca-Ph metabolism, bone markers and adrenal hormo determined using the DXA method in the lumbar spine (BMDlumb) and in the forearm (MBDfore).
Results: No difference was found in the prevalence of osteoporosis or osteopenia in the study group when compared with a control group. BMD was not shown to be dependent either on doses of hydrocortisone (HCT) or HCT doses adjusted to body weight and bo dy surface area; no correlation was found between BMD and duration of replacement therapy. Patients treated with daily HCT doses > 25 mg had significantly lower BMDlumb when compared to those treated with daily doses < 25 mg. Decreased levels of adrenal an drogens and, in females, estradiol were noted. In females only, parameters of Ca-Ph metabolism and bone markers showed decreased levels of serum calcium, increased levels of osteocalcin, bone alkaline phosphatase isoenzyme and 25-hydroxyvitamin D. Neither RANKL nor OPG values in patients were different from those in the control group. A higher RANKL/OPG ratio was observed.
Conclusions: Glucocorticoid therapy alone does not represent a significant risk of increased prevalence of osteoporosis in patients with Addison's disease as it only physiologically replaces insufficient endogenous cortisol. The higher RANKL/OPG ratio may suggest a re lative shortage of OPG. Therefore, female patients may be thought to have increased bone turnover and thus a relatively higher risk of decreased BMD, despite adequate substitution. A potential risk is represented by higher doses of glucocorticoid replacement therapy (daily HCT doses & males, estradiol).
Keywords: hypocorticism, glucocorticoi porosis
Published: December 11, 2008 Show citation
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