Bone mineral density and vitamin D status in children and adolescents with congenital adrenal hyperplasia

Abstract

To determine the prevalence of and risk factors for decreased bone mineral density (BMD) and vitamin D deficiency in children and adolescents with congenital adrenal hyperplasia (CAH). Materials and methods:This study was conducted on 30 girls and 22 boys with CAH (age range = 5-20 years) with median age of 12.0 years. BMD values of lumbar vertebras (L1-L4), which were determined by dual-energy X-ray absorptiometry, were used to calculate z-scores according to chronological age. A serum 25-hydroxyvitamin D level of <15 ng/mL was considered as indicative of vitamin D deficiency.Results: Mean vitamin D level was 14.8 ng/mL in the whole group. Twenty-seven (51.9%) children had vitamin D deficiency and it was more prevalent during pubertal ages. Vitamin D levels were found to be significantly lower in pubertal females. BMD z-score was below -1 standard deviation in 40.1% of cases with significantly higher mean age and lower vitamin D levels. Conclusion:Decreased BMD z-score and vitamin D deficiency were common in these children with CAH. Vitamin D levels were significantly lower in girls and pubertal children. Decreased BMD z-score was related to older age and lower levels of vitamin D. Periodical controls of vitamin D status and vitamin D supplementation were recommended in these cases, whenever required.

Bone mineral density and body composition in children with congenital adrenal hyperplasia

“…Among studies that reported decreased BMD in CAH children compared to controls, two studies found that higher HC dose (or its equivalents) was associated with lower BMD Z‐scores, whereas Demirel et al and our study found no association. The rest of the studies did not examine this relationship .…”

“…Demirel et al 15 and our study found no association. The rest of the studies did not examine this relationship.…”

“…While studies in the literature have assessed BMD in children with CAH, comparison between the studies is difficult due to varying age ranges (and pubertal stage), dosage and type of glucocorticoid used; inconsistently reported subtypes; and variable measures of control assessment of androgen exposure. Therefore, it is not surprising that studies have reported BMD to be reduced, increased and or no different in children with CAH.…”

“…Evidence for the effects of increased adrenal sex steroids in CAH and glucocorticoid therapy on bone mineral density (BMD) are mixed, with some studies finding no difference in BMD between children with CAH and controls, [3][4][5][6][7][8] others finding lower BMD in children with CAH, [9][10][11][12][13][14][15] and one study finding increased BMD. 16 While androgens have an established positive effect on BMD through stimulation of osteoblastic activity, 17 glucocorticoids can have an opposite detrimental effect.…”

Bone mineral density in young adult women with congenital adrenal hyperplasia

“…Poor control, prednisolone use, use of hydrocortisone doses more than 20 mg/m 2 , longer duration, low 25 hydroxy Vitamin D, and higher 17-OHP levels were all associated with low BMD. [ 13 14 15 ]…”