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Real-world impact of glucocorticoid replacement therapy on bone mineral density: retrospective experience of a large single-center CAH cohort spanning 24 years

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Abstract

Summary

The congenital adrenal hyperplasia population seems to have an intrinsic tendency to a high frequency of low bone mass. However in this single-center and long-term evaluated cohort, the simplified corticoid regimen, with exclusive dexamethasone single dose reposition during adulthood, did not represent a risk factor for decrease in bone health.

Introduction

The impact of long-term and supposedly physiological doses of gluco and mineralocorticoid (GC/MC) on bone mineral density (BMD) in congenital adrenal hyperplasia (CAH) remains discordant among studies, which contain different clinical forms and corticoid regimens. Our aim was to evaluate the BMD in CAH adults receiving similar GC regimen since childhood and to correlate it with GC/MC cumulative doses.

Methods

Only patients with good compliance, who used cortisone acetate (CA) during childhood and dexamethasone after the final height achievement. Cumulative GC/MC doses were calculated from diagnosis until last evaluation. BMD was analyzed by the first and last energy X-ray absorptiometry (DXA) scans performed.

Results

Twenty simple virilizing (SV) and 14 salt wasting (WS) whose mean age was 26 ± 6 years, mean CA, dexamethasone, and fludrocortisone cumulative doses were 63,813 ± 32,767, 812 ± 558, and 319 ± 325 mg/m2, respectively. Based on the last DXA, low BMD was observed in 11% of patients, total hip Z-score was lower in the SW than SV form (p = 0.04). Cumulative CA dose had an inverse correlation with femoral neck Z-score (p < 0.01). Total cumulative GC and MC doses had an inverse correlation with total hip Z-score (p < 0.01). In the analysis of sequential BMD during dexamethasone therapy, no association was observed among cumulative GC/MC doses, clinical forms, sex, and lumbar Z-score delta.

Conclusions

Even though a low CA regimen during growth periods in addition to MC replacement appears to have an influence on BMD at femoral sites, interestingly a low dexamethasone one does not seem to be deleterious for bone health in adulthood.

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Funding

Iervolino LL was supported by the FAPESP (grant number 2016/09674-2).

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Authors and Affiliations

  1. Faculty of Medicine, University of Sao Paulo, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil

    L. L. Iervolino

  2. Laboratório de Endocrinologia Celular e Molecular LIM 25 e Unidade de Doencas Osteometabolicas, Divisao de Endocrinologia, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of Sao Paulo, Av. Dr. Arnaldo, 455 sala 4344, Cerqueira Cesar, Sao Paulo, SP, 01246-903, Brazil

    B. Ferraz-de-Souza

  3. Laboratório de Hormônios e Genética Molecular LIM 42, Divisao de Endocrinologia, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 2° andar bloco 6, Cerqueira Cesar, Sao Paulo, SP, 05403-900, Brazil

    R. M. Martin, F. C. Costa, M. C. Miranda, B. B. Mendonça & T. S. Bachega

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  1. L. L. Iervolino
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  2. B. Ferraz-de-Souza
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  3. R. M. Martin
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  4. F. C. Costa
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  5. M. C. Miranda
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  6. B. B. Mendonça
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  7. T. S. Bachega
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Correspondence to T. S. Bachega.

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Iervolino, L.L., Ferraz-de-Souza, B., Martin, R.M. et al. Real-world impact of glucocorticoid replacement therapy on bone mineral density: retrospective experience of a large single-center CAH cohort spanning 24 years. Osteoporos Int 31, 905–912 (2020). https://doi.org/10.1007/s00198-019-05268-0

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  • DOI: https://doi.org/10.1007/s00198-019-05268-0

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