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Skeletal Microstructure in Addison's Disease.

Leonardo Bandeira1,2, Rodrigo Nolasco Dos Santos1, Gustavo de Paula Ripka1

  • 1Division of Endocrinology, Department of Medicine, Universidade Federal de Sao Paulo, Sao Paulo 04077-020, Brazil.

Journal of the Endocrine Society
|December 11, 2025
PubMed
Summary
This summary is machine-generated.

Addison's disease patients exhibit reduced lean mass and bone fragility, particularly in the tibia, due to glucocorticoid (GC) treatment. This study highlights potential skeletal risks associated with GC replacement therapy.

Keywords:
Addison's diseaseHRpQCTbone microarchitectureglucocorticoidmicrostructureskeletal

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Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Medical Imaging

Background:

  • Addison's disease (AD) involves deficient adrenal glucocorticoid (GC) production, necessitating GC replacement therapy.
  • High-dose GC treatment can lead to adverse effects, and bone mineral density (BMD) data in AD patients are conflicting.
  • High-resolution peripheral quantitative computed tomography (HRpQCT) offers detailed assessment of bone microarchitecture and mechanical properties, but has not been used in AD.

Purpose of the Study:

  • To evaluate bone health in Addison's disease patients using HRpQCT.
  • To compare bone quality and microarchitecture between AD patients on GC therapy and healthy controls.
  • To investigate potential correlations between lean mass, GC dose, and skeletal parameters in AD.

Main Methods:

  • A cross-sectional study comparing 19 AD patients on GC therapy with 38 matched controls.
  • Utilized dual-energy x-ray absorptiometry and HRpQCT to measure volumetric BMD, microarchitecture, and mechanical properties of the tibia and radius.
  • Analyzed differences in bone parameters and correlations between lean mass, cumulative GC dose, and bone health outcomes.

Main Results:

  • AD patients showed significantly lower lean mass and BMD compared to controls.
  • HRpQCT revealed reduced trabecular bone number and volumetric BMD, increased trabecular separation, and diminished cortical bone dimensions at the tibia.
  • Tibial stiffness was 21% lower in AD patients, with correlations observed between lean mass and stiffness, and cumulative GC dose and spine BMD.

Conclusions:

  • This is the first study to use HRpQCT to assess bone quality in AD patients on GC therapy.
  • Findings indicate that AD patients experience loss of lean mass and skeletal fragility, predominantly affecting the tibia's trabecular compartment.
  • Bone loss in AD may be linked to both reduced lean mass and the effects of GC treatment.