title: What is the optimal bone-preserving strategy for patients with Addison's disease?
abstract: Addison's disease is associated with low bone mineral density and increased risk of hip fractures. Causes are multifactorial, contributed by underlying adrenocortical hormonal deficiency, associated autoimmune endocrinopathies, electrolyte disturbances and, in some patients, supraphysiologic glucocorticoid replacement. Recent realization of physiologic cortisol production rate has revised downwards glucocorticoid replacement dosages. Meanwhile, new research has emerged suggesting complex interplay between sodium and calcium homoeostasis under the influence of mineralocorticoid and parathyroid hormone that may impact bone health. As the prevalence of Addison's disease is rising, and osteoporosis and fractures are associated with significant morbidity and increased mortality, attention to bone preservation in Addison's disease is of clinical relevance and importance. We suggest an approach to bone health in Addison's disease integrating physiologic adrenocortical hormonal replacement with electrolyte and mineral homoeostasis optimization.
authors: Department of Endocrinology, St Vincent's Hospital and Diabetes and Metabolism Branch, Garvan Institute of Medical Research, Sydney, NSW, Australia.
authors: Paul
authors: P
authors: Lee
authors: Department of Endocrinology, St Vincent's Hospital and Diabetes and Metabolism Branch, Garvan Institute of Medical Research, Sydney, NSW, Australia.
authors: Jerry R
authors: JR
authors: Greenfield
mesh_terms: D000224:Addison Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D000728:Androgens / Q000378:metabolism; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D019314:Dehydroepiandrosterone Sulfate / Q000737:chemistry; D004573:Electrolytes; D005260:Female; D005272:Femur Neck / Q000473:pathology; D008401:Gas Chromatography-Mass Spectrometry; D005938:Glucocorticoids / Q000378:metabolism; D006620:Hip Fractures / Q000517:prevention & control; D006728:Hormones / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007010:Hyponatremia / Q000097:blood; D007037:Hypothyroidism / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000517:prevention & control; D011859:Radiography; D012083:Renin / Q000097:blood; D012306:Risk; D013131:Spine / Q000473:pathology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000737:chemistry / Q000378:metabolism
chemical_list: D000728:Androgens; D004573:Electrolytes; D005938:Glucocorticoids; D006728:Hormones; D014807:Vitamin D; D019314:Dehydroepiandrosterone Sulfate; C104450:25-hydroxyvitamin D; D012083:Renin; D006854:Hydrocortisone