Real-world impact of glucocorticoid replacement therapy on bone mineral density: retrospective experience of a large single-center CAH cohort spanning 24 years

Autor(es)

Iervolino, L. L. ^[1] ; Ferraz-de-Souza, B. ^{[2, 3]} ; Martin, R. M. ^[4] ; Costa, F. C. ^[4] ; Miranda, M. C. ^[4] ; Mendonca, B. B. ^[4] ; Bachega, T. S. ^[4]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Ave Dr Arnaldo 455, BR-01246903 Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Lab Endocrinol Celular & Mol LIM 25, Hosp Clin HCFMUSP, Fac Med, Div Endocrinol, Ave Dr Arnaldo 455 Sala 4344, BR-01246903 Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Unidade Doencas Osteometab, Hosp Clin HCFMUSP, Fac Med, Div Endocrinol, Ave Dr Arnaldo 455 Sala 4344, BR-01246903 Sao Paulo, SP - Brazil

^[4] Univ Sao Paulo, Lab Hormonios & Genet Mol LIM 42, Hosp Clin HCFMUSP, Fac Med, Div Endocrinol, Ave Dr Eneas de Carvalho Aguiar 155, BR-05403900 Sao Paulo, SP - Brazil

• Tipo de documento: Artigo Científico
• Fonte: OSTEOPOROSIS INTERNATIONAL; v. 31, n. 5 JAN 2020.
• Citações Web of Science: 0

Resumo

The congenital adrenal hyperplasia population seems to have an intrinsic tendency to a high frequency of low bone mass. However in this single-center and long-term evaluated cohort, the simplified corticoid regimen, with exclusive dexamethasone single dose reposition during adulthood, did not represent a risk factor for decrease in bone health. Introduction The impact of long-term and supposedly physiological doses of gluco and mineralocorticoid (GC/MC) on bone mineral density (BMD) in congenital adrenal hyperplasia (CAH) remains discordant among studies, which contain different clinical forms and corticoid regimens. Our aim was to evaluate the BMD in CAH adults receiving similar GC regimen since childhood and to correlate it with GC/MC cumulative doses. Methods Only patients with good compliance, who used cortisone acetate (CA) during childhood and dexamethasone after the final height achievement. Cumulative GC/MC doses were calculated from diagnosis until last evaluation. BMD was analyzed by the first and last energy X-ray absorptiometry (DXA) scans performed. Results Twenty simple virilizing (SV) and 14 salt wasting (WS) whose mean age was 26 +/- 6 years, mean CA, dexamethasone, and fludrocortisone cumulative doses were 63,813 +/- 32,767, 812 +/- 558, and 319 +/- 325 mg/m(2), respectively. Based on the last DXA, low BMD was observed in 11% of patients, total hip Z-score was lower in the SW than SV form (p = 0.04). Cumulative CA dose had an inverse correlation with femoral neck Z-score (p < 0.01). Total cumulative GC and MC doses had an inverse correlation with total hip Z-score (p < 0.01). In the analysis of sequential BMD during dexamethasone therapy, no association was observed among cumulative GC/MC doses, clinical forms, sex, and lumbar Z-score delta. Conclusions Even though a low CA regimen during growth periods in addition to MC replacement appears to have an influence on BMD at femoral sites, interestingly a low dexamethasone one does not seem to be deleterious for bone health in adulthood. (AU)

• Processo FAPESP: 16/09674-2 - Análise da densidade mineral óssea de pacientes com hiperplasia adrenal congênita por deficiência da enzima 21-hidroxilase: correlação com a dose cumulativa de glicocorticóide e com polimorfismos no gene do receptor de glicocorticóide
• Beneficiário: Luiz Guilherme Cimino Lerario Iervolino
• Linha de fomento: Bolsas no Brasil - Iniciação Científica