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Cited by 79Sexual Differentiation and DisordersBone health and osteoporosis researchAdrenal Hormones and Disorders

Bone turnover and bone mineral density in patients with congenital adrenal hyperplasia

Guo, C‐Y., Weetman, A. P., Eastell, R.·1996·Clinical Endocrinology
DOI 10.1046/j.1365-2265.1996.00851.x
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Abstract

BACKGROUND AND OBJECTIVE Glucocorticoid replacement is the most effective therapy for patients with congenital adrenal hyperplasia (CAH). It has been reported that excessive steroid therapy leads to bone loss and osteoporosis, but it is uncertain whether steroid replacement therapy affects bone turnover and bone mineral density (BMD) in adult patients with CAH. DESIGN Case‐control study: patients with CAH were compared to normal subjects, individually matched for age and body weight. PATIENTS Eleven patients, aged 19–65 years, were evaluated in this study. The age at diagnosis of CAH was 0–26 years. Nine patients (6 females and 3 males) were diagnosed with 21‐hydroxylase deficiency and 2 male patients with 11‐hydroxylase deficiency. 17‐Hydroxyprogesterone levels in patients had never been below the reference range in the previous 2 years. These patients were individually matched for sex, age and weight to 11 healthy controls. MEASUREMENTS Total body, lumbar spine and femoral neck BMD was measured by dual‐energy X‐ray absorptiometry. Serum bone Gla‐protein (BGP, osteocalcin) and bone alkaline phosphatase (BAP) were measured to assess bone formation whereas serum tartrate‐resistant acid phosphatase (TRAP) and urinary cross‐linked N‐telopeptides of type I collagen (NTx) were measured to assess bone resorption. NTx was expressed as a fraction of urinary creatinine excretion (NTx/Cr). Serum dehydroepiandrosterone sulphate (DHEA‐S) and androstenedione levels were measured to assess adrenal androgen status. RESULTS Serum DHEA‐S, androstenedione, BGP and BAP and urinary NTx/Cr were decreased in patients when compared with controls (paired t‐test, P = 0.005, 0.0003, 0.002, 0.03 and 0.03, respectively). BMD was not significantly decreased in patients. The difference of total body BMD between patients and controls (i.e. BMD in patients minus BMD in controls) was negatively correlated with age. There was no correlation between androgen levels and either BMD or bone turnover. The total dose of steroid taken in the previous 2 years was not correlated with BMD, bone turnover or androgen levels. The was no correlation between BMD adjusted by age and bone turnover or initial age at diagnosis. CONCLUSIONS We conclude that (1) bone turnover is decreased in congenital adrenal hyperplasia, (2) bone mineral density is not decreased in congenital adrenal hyperplasia and (3) patients initially have higher bone mineral density but later have lower bone mineral density than controls, especially in women.

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Authors
Guo, C., Weetman, A. P., & Eastell, R.
Affiliations
Northern General Hospital (GB)
Corresponding author
Eastell, R.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
1996-11
Volume
45
Issue
5
Pages
535-541
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1046/j.1365-2265.1996.00851.x
OpenAlex
W2030167430
Cited by
79
References
36
Citations by year
2026: 1 · 2025: 5 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 3 · 2016: 1 · 2015: 3 · 2014: 1 · 2013: 1 · 2012: 4
FWCI
0.38
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2553 d)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
congenital adrenal hyperplasia, bone turnover, bone mineral density, glucocorticoid replacement therapy, osteoporosis, 21-hydroxylase deficiency, 11beta-hydroxylase deficiency, bone resorption, bone formation, androgens, DHEA sulfate, androstenedione, osteocalcin, tartrate-resistant acid phosphatase
MeSH terms
Adrenal Hyperplasia, Congenital, Adult, Aged, Androstenedione, Bone and Bones, Female, Glucocorticoids, Humans, Male, Middle Aged, Bone Density, Case-Control Studies, Bone Remodeling, Dehydroepiandrosterone Sulfate

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