Bone Mineral Density in Children and Adolescents with Congenital Adrenal Hyperplasia

Abstract

Chronic glucocorticoid therapy is associated with reduced bone mineral density. In paediatric patients with congenital adrenal hyperplasia, increased levels of androgens could not only counteract this effect, but could also advance bone age, with interference in the evaluation of densitometry. We evaluate bone mineral density in paediatric patients with classic congenital adrenal hyperplasia taking into account chronological and bone ages at the time of the measurement. Patients aged between 5 and 19 years underwent radiography of the hand and wrist followed by total body and lumbar spine densitometry. Chronological and bone ages were used in the scans interpretation. In fourteen patients, mean bone mineral density Z-score of total body to bone age was −0.76 and of lumbar spine to bone age was −0.26, lower than those related to chronological age (+0.03 and +0.62, resp.). Mean Z-score differences were statistically significant (P = 0.004 for total body and P = 0.003 for lumbar spine). One patient was classified as having low bone mineral density only when assessed by bone age. We conclude that there was a reduction in the bone mineral density Z-score in classic congenital adrenal hyperplasia paediatric patients when bone age was taken into account instead of chronological age.

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

“…[3][4][5][6][7][8]11 In some of these studies, national reference data were used instead of age-matched, sexmatched and BMI-matched controls 3,4,7,11 ; BMD was not adjusted for height-for-age Z-score, [4][5][6][7][8] which could lead to underestimation or overestimation of BMD Z-score 25 ; the CAH subtype 3,4 or the type of glucocorticoid was not always specified 4,7 ; and in one study, only females with CAH were evaluated. 8 Three of these studies found no association between HC dose and BMDZ-scores, 4,8,11 and the rest did not examine the relationship. 3,[5][6][7] Only one study found increased BMD in children with CAH, 16 but that study differed from ours in that it included not only children with 21-hydroxylase deficiency but also 11β-hydroxylase deficiency;…”

“…In some of these studies, national reference data were used instead of age‐matched, sex‐matched and BMI‐matched controls; BMD was not adjusted for height‐for‐age Z‐score, which could lead to underestimation or overestimation of BMD Z‐score; the CAH subtype or the type of glucocorticoid was not always specified; and in one study, only females with CAH were evaluated . Three of these studies found no association between HC dose and BMDZ‐scores, and the rest did not examine the relationship …”

“…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.…”