The effect of glucocorticoid therapy on bone mineral density in children and adolescents with congenital adrenal hyperplasia

Background: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive diseases caused by a deficiency in adrenal enzymes that lead to changes in cortisol and aldosterone levels. Objective: This study aimed to assess the bone mineral density of the spine and femoral head in children and adolescents aged 5 and 20 years, suffering from different types of congenital adrenal hyperplasia and treated with corticosteroids and to study the associated factors. Materials and method: We studies 44 patients, 26 girls and 18 boys, who were treated with corticosteroids with a physiological dose of 15-20 mg/m2 since infancy. A questionnaire was completed by patients and their parents admitted to the Endocrinology Clinic of Imam Reza Hospital of Mashhad. The patients' bone density was then measured, and the association with different factors, such as age, gender, height, weight, type of CAH, type and duration of receiving corticosteroids, the 17-hydroxyprogesterone level, bone activity markers, vitamin D level, and puberty stage, was analyzed, using SPSS software. Result: No significant correlation between the bone density level and variables such as the duration and dose of corticosteroid consumption, age, sex, time of diagnosis, 17-hydroxyprogesterone level, calcium, and phosphorus, was found. Other variables such as height, weight, puberty stage, and vitamin D levels were found to play a significant role in determining the bone density level. Conclusion: It is highly recommended to consider the side effects and complications when starting treatment with corticosteroids in patients with CAH. Bone densitometry should regularly be done, osteoporosis prophylaxis should be considered using weight-bearing exercises and calcium and vitamin D supplements, and the level of vitamin D should be monitored.