Long-term follow-up of bone mineral density in Addison's disease.
OBJECTIVE
There is conflicting evidence regarding the long-term effects of long-term glucocorticoid replacement therapy (GRT) on bone mineral density (BMD) in patients with chronic adrenal insufficiency. Our aim was to evaluate bone turnover and changes in BMD in patients on GRT.


METHODS
We have studied 25 subjects (six men, 19 women; aged 62.4 +/- 11.3 years, duration of disease 21.7 +/- 11.7 years, fasting cortisol 63 +/- 36 nmol/l) on GRT (hydrocortisone 30 mg/day or prednisone 7.5 mg/day). BMD was assessed at the lumbar spine (LS; L2-L4), proximal femur (PF) and ultra distal radius (UR) by dual energy X-ray absorptiometry (DXA). The rates of bone loss were calculated using previous DXA measurements at the LS (48 and 60 months earlier). Serum calcium, phosphate alkaline phosphatase (ALP), bone ALP, serum osteocalcin (BGP), intact parathyroid hormone (PTH) and 25(OH) vitamin D were also measured.


RESULTS
BMD [Z-score; 95% confidence interval (95% CI)] was normal at the LS: (-1.15-+0.07); PF: (-0.90-+0.22) and UDR (-0.77-+0.36). No significant differences were found according to the type of replacement therapy or sex. No significant bone loss (g/cm2; 95% CI) was detected at the LS: (-0.021-+0.023). Fifty-six per cent of patients met osteoporotic criteria; a greater proportion of patients treated with prednisone had osteoporosis compared with those an hydrocortisone. All bone markers were in their normal ranges.


CONCLUSIONS
Patients on long-term therapy do not show accelerated bone loss at the lumbar spine. Nevertheless, a considerable proportion of patients, mainly those treated with prednisone, showed densitometric osteoporosis.
Jódar
Esteban
E
Services of Endocrinology, University Hospital 12 de Octubre, Madrid, Spain.
Valdepeñas
María Pilar Ruiz
MP
Martinez
Guillermo
G
Jara
Antonino
A
Hawkins
Federico
F
D000224:Addison Disease / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000704:Analysis of Variance; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008159:Lumbar Vertebrae / Q000378:metabolism; D008297:Male; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010024:Osteoporosis / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000097:blood; D011241:Prednisone / Q000627:therapeutic use; D014807:Vitamin D / Q000097:blood
D010281:Parathyroid Hormone; D015675:Osteocalcin; D014807:Vitamin D; D000469:Alkaline Phosphatase; D011241:Prednisone; D006854:Hydrocortisone