title: Long-term glucocorticoid effect on bone mineral density in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.
abstract: BACKGROUND
  Patients with 21-hydroxylase deficiency (21OHD) assume a lifelong glucocorticoid (GC) therapy. Excessive GC treatment increases the risk of osteoporosis and bone fractures, even though the role of substitutive therapy is not fully established: we analyzed the effect of GC dose on bone metabolism and bone mineral density (BMD) over time in patients with 21OHD.
  
  
  METHODS
  We studied bone metabolism markers and BMD in 38 adult patients with 21OHD (19-47 years, 24 females and 14 males) and 38 matched healthy control. In 15 patients, BMD data were available at both baseline and after a long-term follow-up.
  
  
  RESULTS
  BMD was lower in patients than in controls at lumbar spine (0.961±0.1g/cm(2) vs 1.02±0.113g/cm(2), P=0.014) and femur neck (0.736±0.128g/cm(2) vs 0.828±0.103g/cm(2), P=0.02); otherwise, after height correction, only femoral neck BMD was lower in patients (0.458±0.081g/cm(2) vs 0.498±0.063g/cm(2), P=0.028). In those 21OHD subjects with at least 10 years follow-up, we observed an increase in lumbar BMD (P=0.0429) and a decrease in femur neck BMD values (P=0.004). Cumulative GC dose was not related to bone metabolism or BMD. No patient experienced clinical fragility fractures.
  
  
  CONCLUSIONS
  BMD values are decreased in patients with 21OHD, which are in part explained by decreased height, but not by the dose of glucocorticoids. Nevertheless, bone status should be carefully monitored in patients with 21OHD.
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy ceccato.filippo@gmail.com.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ceccato
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Barbot
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Nora
authors.initials: N
authors.lastname: Albiger
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Zilio
authors.affiliation: Geriatric ClinicUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: De Toni
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Luisetto
authors.affiliation: Laboratory Medicine UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Zaninotto
authors.affiliation: Pediatrics Endocrinology and Adolescence UnitDepartment of Woman and Child Health, University-Hospital of Padova, Padova, Italy.
authors.forename: Nella Augusta
authors.initials: NA
authors.lastname: Greggio
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Boscaro
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Scaroni
authors.affiliation: Endocrinology UnitUniversity-Hospital of Padova, Padova, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Camozzi
mesh_terms: D015502:Absorptiometry, Photon; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy*; D000328:Adult; D015519:Bone Density / Q000187:drug effects*; D003907:Dexamethasone / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000187:drug effects*; D050723:Fractures, Bone / Q000139:chemically induced / Q000000981:diagnostic imaging; D005938:Glucocorticoids / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D011239:Prednisolone / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone; D006854:Hydrocortisone