title: Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency.
abstract: OBJECTIVE
  It remains controversial whether long-term glucocorticoids are charged of bone demineralization in patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The aim of this study was to know whether cumulative glucocorticoid dose from the diagnosis in childhood to adulthood in patients with CAH had a negative impact on bone mineral density (BMD).
  
  
  METHODS
  This was a retrospective study.
  
  
  METHODS
  Thirty-eight adult patients with classical and non-classical CAH were included. BMD was measured in the lumbar spine and femoral neck. Total cumulative glucocorticoid (TCG) and total average glucocorticoid (TAG) doses were calculated from pediatric and adult files.
  
  
  RESULTS
  We showed a difference between final and target heights (-0.82+/-0.92 s.d. for women and -1.31+/-0.84 s.d. for men; P<0.001). Seventeen patients (44.7%) had bone demineralization (35.7% of women and 70% of men). The 28 women had higher BMD than the 10 men for lumbar (-0.26+/-1.20 vs -1.25+/-1.33 s.d.; P=0.02) and femoral T-scores (0.21+/-1.30 s.d. versus -1.08+/-1.10 s.d.; P=0.007). In the salt-wasting group, women were almost significantly endowed with a better BMD than men (P=0.053). We found negative effects of TCG, TAG on lumbar (P<0.001, P=0.002) and femoral T-scores (P=0.006, P<0.001), predominantly during puberty. BMI was protective on BMD (P=0.006).
  
  
  CONCLUSIONS
  The TCG is an important factor especially during puberty for a bone demineralization in patients with 21-hydroxylase deficiency. The glucocorticoid treatment should be adapted particularly at this life period and preventive measures should be discussed in order to limit this effect.
authors.affiliation: AP-HP, Department of Endocrinology and Reproductive Medicine, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Chakhtoura
authors.forename: Anne
authors.initials: A
authors.lastname: Bachelot
authors.forename: Dinane
authors.initials: D
authors.lastname: Samara-Boustani
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Ruiz
authors.forename: Bruno
authors.initials: B
authors.lastname: Donadille
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dulon
authors.forename: Sophie
authors.initials: S
authors.lastname: Christin-Maître
authors.forename: Claire
authors.initials: C
authors.lastname: Bouvattier
authors.forename: Marie-Charles
authors.initials: MC
authors.lastname: Raux-Demay
authors.forename: Philippe
authors.initials: P
authors.lastname: Bouchard
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Carel
authors.forename: Juliane
authors.initials: J
authors.lastname: Leger
authors.forename: Frédérique
authors.initials: F
authors.lastname: Kuttenn
authors.forename: Michel
authors.initials: M
authors.lastname: Polak
authors.forename: Philippe
authors.initials: P
authors.lastname: Touraine
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics; D000328:Adult; D001827:Body Height / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011627:Puberty / Q000187:drug effects; D012189:Retrospective Studies; D013255:Steroid 21-Hydroxylase / Q000235:genetics / Q000378:metabolism*
chemical_list: D005938:Glucocorticoids; D013255:Steroid 21-Hydroxylase