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Bone Mineral Density in Patients With Congenital Adrenal Hyperplasia From Prepubertal to Adult Age
Marianna Rita Stancampiano1, Marco Pitea1, Katia Maruca1,2
1Department of Pediatrics, Endocrine Unit, Endo-ERN Center for Rare Endocrine Diseases, IRCCS San Raffaele Hospital, 20132 Milan, Italy.
Context:
Patients affected by the classic form of congenital adrenal hyperplasia (CAH) need lifelong glucocorticoid (GC) therapy. GC represents one of the primary causes of secondary osteoporosis; however, the effect of steroid therapy on bone mineral density (BMD) in patients with CAH is still controversial.
Objective:
To evaluate and compare the BMD of a group of prepubertal patients and a subgroup of young adult patients with CAH receiving chronic GC therapy, with healthy controls.
Design:
Retrospective observational study.
Setting:
A referral center for pediatric endocrinology.
Patients And Healthy Controls:
Fifty-six prepubertal children with CAH treated with GC from diagnosis and 60 prepubertal healthy children of comparable age. A subgroup of 36 young patients was studied after the completion of puberty, and their BMD was compared to that of 51 young adult healthy volunteers.
Methods:
BMD was measured in the lumbar spine and in the whole body by dual-energy x-ray absorptiometry. Multivariate models were used for the comparison of BMD measurements between patients and control subjects.
Results:
Whole-body BMD measurements of patients were significantly lower compared with healthy controls, both in boys and in girls. No differences were found in lumbar spine measurements. BMD expressed as Z-score decreased markedly in CAH patients from prepuberty to adulthood, particularly in young adult males. Men with CAH showed lumbar spine BMD values significantly lower than control subjects.
Conclusion:
Boys and young adult men with classic form of CAH have lower BMD values compared with healthy controls. This may put them at risk of developing osteoporosis early in life.
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