Bone Mineral Density in Patients With Congenital Adrenal Hyperplasia From Prepubertal to Adult Age.

Abstract

Context: Patients affected by the classic form of congenital adrenal hyperplasia (CAH) need lifelong glucocorticoid (GC) therapy. GC represents one of the primary causes of secondary osteoporosis; however, the effect of steroid therapy on bone mineral density (BMD) in patients with CAH is still controversial.

Objective: To evaluate and compare the BMD of a group of prepubertal patients and a subgroup of young adult patients with CAH receiving chronic GC therapy, with healthy controls.

Design: Retrospective observational study.

Setting: A referral center for pediatric endocrinology.

Patients and healthy controls: Fifty-six prepubertal children with CAH treated with GC from diagnosis and 60 prepubertal healthy children of comparable age. A subgroup of 36 young patients was studied after the completion of puberty, and their BMD was compared to that of 51 young adult healthy volunteers.

Methods: BMD was measured in the lumbar spine and in the whole body by dual-energy x-ray absorptiometry. Multivariate models were used for the comparison of BMD measurements between patients and control subjects.

Results: Whole-body BMD measurements of patients were significantly lower compared with healthy controls, both in boys and in girls. No differences were found in lumbar spine measurements. BMD expressed as Z-score decreased markedly in CAH patients from prepuberty to adulthood, particularly in young adult males. Men with CAH showed lumbar spine BMD values significantly lower than control subjects.

Conclusion: Boys and young adult men with classic form of CAH have lower BMD values compared with healthy controls. This may put them at risk of developing osteoporosis early in life.