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Glucocorticoid replacement therapy is independently associated with reduced bone mineral density in women with

Oskar Ragnarsson1, Helena Filipsson Nyström, Gudmundur Johannsson

  • 1Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden. oskar.ragnarsson@medic.gu.se

Clinical Endocrinology
|July 20, 2011
PubMed

Insights

Glucocorticoid (GC) replacement in women with ACTH insufficiency (ACTHins) and hypopituitarism is linked to lower bone mineral density (BMD) and osteopenia. The average GC dose did not show adverse metabolic effects in these patients.

Area of Science:

  • Endocrinology
  • Metabolic Medicine
  • Bone Health

Background:

  • Hypopituitarism is associated with cardiovascular morbidity and reduced bone mineral density (BMD).
  • Glucocorticoid (GC) replacement is a standard treatment for ACTH insufficiency (ACTHins) in hypopituitary patients.
  • The impact of GC replacement on cardiovascular risk and BMD requires further investigation.

Purpose of the Study:

  • To analyze the effects of glucocorticoid (GC) replacement on cardiovascular risk factors and BMD in hypopituitary patients.
  • To compare cardiovascular risk profiles and BMD between ACTH sufficient (ACTHsuff) and ACTHins patients.
  • To determine if current GC dosing strategies are associated with adverse metabolic profiles.

Main Methods:

  • Cross-sectional study of 365 hypopituitary patients.
  • Categorization into ACTH insufficient (ACTHins, n=204) and ACTH sufficient (ACTHsuff) groups.
  • Analysis of BMD and cardiovascular risk factors using multiple linear and logistic regression, comparing ACTHins and ACTHsuff patients before GH replacement.

Main Results:

  • ACTHins was linked to lower fasting glucose but not other cardiovascular risk factors.
  • ACTHins women receiving a mean hydrocortisone equivalent (HCeq) dose of 20.5 mg/day showed decreased BMD at the lumbar spine and femoral neck, and increased osteopenia prevalence.
  • No significant difference in BMD was observed between ACTHins and ACTHsuff men.

Conclusions:

  • Current average GC doses (approx. 20 mg HCeq/day) are not associated with adverse metabolic profiles in hypopituitary patients.
  • GC replacement in ACTHins women is independently associated with reduced BMD and a higher prevalence of osteopenia.
  • Gender-specific effects of GC replacement on bone health in hypopituitarism warrant further attention.
Abstract

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