title: Correlation of Bone Mineral Parameters with Anthropometric Measurements and the Effect of Glucocorticoids on Bone Mineral Parameters in Congenital Adrenal Hyperplasia.
abstract: OBJECTIVE
  To correlate the bone mineral parameters [bone mineral content (BMC) and bone mineral density (BMD)] using Dual energy X ray Absorptiometry (DXA) scan with anthropometric measurements and to study the effect of glucocorticoid therapy on BMC/BMD in children with Congenital adrenal hyperplasia (CAH).
  
  
  METHODS
  A cross-sectional study was carried out in the Pediatric Endocrinology unit from January 2012 through March 2013 at Kanchi Kamakoti CHILDS Trust hospital, Chennai. Thirteen CAH children aged 0-132 mo with classic salt wasting due to 21 hydroxylase deficiency were included in the study. All children were treated with T.hydrocortisone @10-15 mg/m(2)/d twice daily and T. fludrocortisone 50 μg once daily orally at the time of enrollment into the study. The duration of glucocorticoid (hydrocortisone) treatment from the date of diagnosis till the time of enrollment into the study was noted and categorized as children receiving < 5 and > 5 y of glucocorticoid therapy. None received Vitamin D/calcium supplementation at the time of enrollment. BMC and areal BMD for the lumbar spine and total body less head (TBLH) were measured with Lunar DXA machine.
  
  
  RESULTS
  The mean height, weight and BMI of children were 87.3 ± 33 cm, 13.49 ± 11.2 kg and 14 ± 4.07 kg/m(2) respectively. TBLH BMC was 369.14 ± 312.18 g and TBLH BMD was 0.63 ± 0.11 g/cm(2). There was a significant correlation between height and total body less head BMC/BMD in the index series [P < 0.05, significant]. The TBLH and spine BMD were also assessed with regards to the duration of glucocorticoid therapy and it has been observed that TBLH and spine BMD decreased with increased duration of steroid therapy (p < 0.05, significant).
  
  
  CONCLUSIONS
  In the absence of normative data or z scores, BMC/BMD correlates well with height for age. Children who received more than 5 y of glucocorticoid treatment had lower TBLH and spine BMD scores and hence, calcium and Vitamin D supplementation should be considered.
authors.affiliation: Department of Pediatrics, KanchiKamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, 600034, Tamil Nadu, India. ganeped79@rediffmail.com.
authors.forename: Ramaswamy
authors.initials: R
authors.lastname: Ganesh
authors.affiliation: Department of Pediatrics, KanchiKamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, 600034, Tamil Nadu, India.
authors.forename: Natarajan
authors.initials: N
authors.lastname: Suresh
authors.affiliation: Department of Pediatrics, KanchiKamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, 600034, Tamil Nadu, India.
authors.forename: Lalitha
authors.initials: L
authors.lastname: Janakiraman
authors.affiliation: Department of Pediatric Endocrinology, Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai, Tamil Nadu, India.
authors.forename: Karnam
authors.initials: K
authors.lastname: Ravikumar
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy* / Q000453:epidemiology; D000886:Anthropometry / Q000379:methods; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007194:India / Q000453:epidemiology; D000069451:Long Term Adverse Effects / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D013223:Statistics as Topic
chemical_list: D005938:Glucocorticoids
keywords: Bone mineral content; Bone mineral density; Children; Congenital adrenal hyperplasia; Dual energy X ray absorptiometry