scholarly journals Prednisolone is associated with a worse bone mineral density in primary adrenal insufficiency

2018 ◽  
Vol 7 (6) ◽  
pp. 811-818 ◽  
Author(s):  
Kathrin R Frey ◽  
Tina Kienitz ◽  
Julia Schulz ◽  
Manfred Ventz ◽  
Kathrin Zopf ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Bone Mineral ◽  
Immediate Release ◽  
Modified Release ◽  
Mineral Density ◽  
Primary Adrenal Insufficiency ◽  
Z Scores

Context Patients with primary adrenal insufficiency (PAI) or congenital adrenal hyperplasia (CAH) receive life-long glucocorticoid (GC) therapy. Daily GC doses are often above the physiological cortisol production rate and can cause long-term morbidities such as osteoporosis. No prospective trial has investigated the long-term effect of different GC therapies on bone mineral density (BMD) in those patients. Objectives To determine if patients on hydrocortisone (HC) or prednisolone show changes in BMD after follow-up of 5.5 years. To investigate if BMD is altered after switching from immediate- to modified-release HC. Design and patients Prospective, observational, longitudinal study with evaluation of BMD by DXA at visit1, after 2.2 ± 0.4 (visit2) and after 5.5 ± 0.8 years (visit3) included 36 PAI and 8 CAH patients. Thirteen patients received prednisolone (age 52.5 ± 14.8 years; 8 women) and 31 patients received immediate-release HC (age 48.9 ± 15.8 years; 22 women). Twelve patients on immediate-release switched to modified-release HC at visit2. Results Prednisolone showed significantly lower Z-scores compared to HC at femoral neck (−0.85 ± 0.80 vs −0.25 ± 1.16, P < 0.05), trochanter (−0.96 ± 0.62 vs 0.51 ± 1.07, P < 0.05) and total hip (−0.78 ± 0.55 vs 0.36 ± 1.04, P < 0.05), but not at lumbar spine, throughout the study. Prednisolone dose decreased by 8% over study time, but no significant effect was seen on BMD. BMD did not change significantly after switching from immediate- to modified-release HC. Conclusions The use of prednisolone as hormone replacement therapy results in significantly lower BMD compared to HC. Patients on low-dose HC replacement therapy showed unchanged Z-scores within the normal reference range during the study period.

scholarly journals Long-Term Outcomes of Conventional And Novel Steroid Replacement Therapy On Bone Health In Primary Adrenal Insufficiency

2021 ◽  
Author(s):  
Valentina Guarnotta ◽  
Claudia Di Stefano ◽  
Carla Giordano
Keyword(s):  
Alkaline Phosphatase ◽  
Lumbar Spine ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Bone Alkaline Phosphatase ◽  
Primary Adrenal Insufficiency ◽  
Z Scores ◽  
Group A ◽  
Group B

Abstract Purpose: To compare dual-release hydrocortisone (DR-HC) and conventional glucocorticoids (GCs) on bone metabolism in patients with primary adrenal insufficiency (PAI).Methods: Thirty-five patients with PAI maintained conventional GCs (group A), while other 35 were switched to DR-HC (group B). At baseline and after 18, 36 and 60 months of conventional GCs and DR-HC treatment, the clinical and bone metabolic parameters were evaluated. Results: After 60 months of follow-up, patients in group A had a significant increase in Body Mass Index (BMI) (p=0.004) and Waist Circumference (WC) (p=0.026) and a significant decrease in osteocalcin (p=0.002), bone alkaline phosphatase (p=0.029), lumbar spine bone mass density (BMD) T and Z scores (p<0.001 and p=0.001, respectively) than baseline. By contrast, patients in group B had a significant decrease in WC (p=0.047) and increase in bone alkaline phosphatase (p=0.019), lumbar spine BMD T score (p=0.032), femoral neck BMD T and Z scores (p=0.023 and p=0.036, respectively) than baseline. Conclusions: Long-term conventional steroid replacement therapy is associated with a decrease in BMD, notably at lumbar spine, and an increase in vertebral fractures rate. By contrast, DR-HC treatment is associated with improvement of BMD.

scholarly journals The Long-Term Effects of Growth Hormone Replacement on Bone Mineral Density and Trabecular Bone Score: Results of the 10-Year Prospective Follow-up

2021 ◽  
pp. S61-S68
Author(s):  
P. Vaňuga ◽  
M. Kužma ◽  
D. Stojkovičová ◽  
J. Smaha ◽  
P. Jackuliak ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Growth Hormone ◽  
Trabecular Bone ◽  
Replacement Therapy ◽  
Bone Mineral ◽  
Trabecular Bone Score ◽  
Mineral Density ◽  
Gh Replacement

There are only few studies concerning about long-term effect of growth hormone (GH) replacement therapy on bone mineral density and bone microstructure. To assess effect of GH replacement therapy on bone mineral density (BMD) and trabecular bone score (TBS) in adult GH deficient (AGHD) subjects over period of 10 years. From 2005 to 2018, a prospective study of AGHD patients was conducted in national referral center for treatment of GHD. All patients received subcutaneous recombinant human GH in an IGF 1-normalizing regimen once a day. Lumbar spine (L-spine) and total hip (TH) BMD using Hologic densitometers were measured at baseline and every two years during treatment with rhGH. TBS was derived from L1-L4 DXA using iNsight® software (Medimaps, France) at each time point. Periods of measurement were baseline, year 2; 4; 6; 8 and 10. In total, 63 patients (38 males, 25 females, mean age 25.1±16 years) were included in the study. After 10 years of GH treatment, IGF-1 significantly increased (~35 %), with greatest increase at year 2. During 10-year follow-up, L-spine BMD increased approximately of 7 % (NS). TH BMD increase of 11 % during follow-up (p=0.0003). The greatest increment of BMD was achieved at year 6 on both sites, L-spine (+6 %) and TH BMD (+13 %) (p<0.05). There was no significant change of TBS during whole follow-up. In this study, sustaining positive effect of GH replacement therapy on bone density in subjects with adult GH deficiency over 10 years of follow-up was observed. The study did not show effect on TBS, as indirect measure of trabecular bone microarchitecture.

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