title: Bone mineral density is reduced in female but not male subjects with Addison's disease.
abstract: OBJECTIVE
  Bone mineral density (BMD) may be potentially reduced in Addison's disease as a result of excessive glucocorticoid replacement, loss of adrenal androgens or concomitant gonadal or thyroid disease. We have examined clinical and biochemical parameters, and BMD in a group of subjects with Addison's disease.
  
  
  METHODS
  Fourteen patients (9 female mean age 56 years, 5 male mean age 56.6 years) with primary adrenocortical failure (median duration 8.5 yrs) on replacement therapy were studied. Four had hypothyroidism on thyroxine doses (0.1 to 0.15 mg/d). Seven of the 9 females were post menopausal. Mean plasma cortisol levels were calculated from at least five samples in each subject drawn between 3 and 5 hours post dose, and the cortisol replacement dose calculated per unit body mass (mg/kg). BMD was measured by dual energy X-ray absorptiometry (DEXA) at femoral neck and lumbar spine (L2-4) and compared with local reference data.
  
  
  RESULTS
  For women (n = 9) at L2-4 the mean Z score was -1.21 (95% CI -1.69, -0.73), and at femoral neck -0.57 (95% CI -1.15, 0.00). For men (n = 5) at L2-4, the mean Z score was 1.32 (95% CI -0.86, 3.50) and at femoral neck 0.62 (95% CI -0.18, 1.42). For all patients, there was no significant correlation between mean plasma cortisol and Z scores at L2-4 and femoral neck, r = -0.003 and -0.095 respectively; and between duration of Addison's disease and mean Z scores at L2-4 and femoral neck r = -0.043 and 0.143 respectively.
  
  
  CONCLUSIONS
  Women with Addison's disease therefore have a greater than expected reduction in BMD. We postulate that this may be related to loss of adrenal androgens.
authors.affiliation: Department of Endocrinology, Christchurch Hospital.
authors.forename: C M
authors.initials: CM
authors.lastname: Florkowski
authors.forename: S J
authors.initials: SJ
authors.lastname: Holmes
authors.forename: J R
authors.initials: JR
authors.lastname: Elliot
authors.forename: R A
authors.initials: RA
authors.lastname: Donald
authors.forename: E A
authors.initials: EA
authors.lastname: Espiner
mesh_terms: D015502:Absorptiometry, Photon; D000224:Addison Disease / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D005272:Femur Neck / Q000503:physiopathology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012737:Sex Factors; D013122:Spinal Diseases / Q000503:physiopathology
chemical_list: D006854:Hydrocortisone