Real-world impact of glucocorticoid replacement therapy on bone mineral density: retrospective experience of a large single-center CAH cohort spanning 24 years

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art_IERVOLINO_Realworld_impact_of_glucocorticoid_replacement_therapy_on_bone_2020.PDF (413.05 KB)
Citações na Scopus
6
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGER LONDON LTD
Autores
Citação
OSTEOPOROSIS INTERNATIONAL, v.31, n.5, p.905-912, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
The congenital adrenal hyperplasia population seems to have an intrinsic tendency to a high frequency of low bone mass. However in this single-center and long-term evaluated cohort, the simplified corticoid regimen, with exclusive dexamethasone single dose reposition during adulthood, did not represent a risk factor for decrease in bone health. Introduction The impact of long-term and supposedly physiological doses of gluco and mineralocorticoid (GC/MC) on bone mineral density (BMD) in congenital adrenal hyperplasia (CAH) remains discordant among studies, which contain different clinical forms and corticoid regimens. Our aim was to evaluate the BMD in CAH adults receiving similar GC regimen since childhood and to correlate it with GC/MC cumulative doses. Methods Only patients with good compliance, who used cortisone acetate (CA) during childhood and dexamethasone after the final height achievement. Cumulative GC/MC doses were calculated from diagnosis until last evaluation. BMD was analyzed by the first and last energy X-ray absorptiometry (DXA) scans performed. Results Twenty simple virilizing (SV) and 14 salt wasting (WS) whose mean age was 26 +/- 6 years, mean CA, dexamethasone, and fludrocortisone cumulative doses were 63,813 +/- 32,767, 812 +/- 558, and 319 +/- 325 mg/m(2), respectively. Based on the last DXA, low BMD was observed in 11% of patients, total hip Z-score was lower in the SW than SV form (p = 0.04). Cumulative CA dose had an inverse correlation with femoral neck Z-score (p < 0.01). Total cumulative GC and MC doses had an inverse correlation with total hip Z-score (p < 0.01). In the analysis of sequential BMD during dexamethasone therapy, no association was observed among cumulative GC/MC doses, clinical forms, sex, and lumbar Z-score delta. Conclusions Even though a low CA regimen during growth periods in addition to MC replacement appears to have an influence on BMD at femoral sites, interestingly a low dexamethasone one does not seem to be deleterious for bone health in adulthood.
Palavras-chave
Bone mineral density, Classical forms, Congenital adrenal hyperplasia, Cumulative glucocorticoid dose, Long-term dexamethasone therapy, Low glucocorticoid doses
URI
https://observatorio.fm.usp.br/handle/OPI/35852
Referências
  1. Ajish T P, 2014, Indian J Endocrinol Metab, V18, P815, DOI 10.4103/2230-8210.141358
  2. [Anonymous], 2010, GLOB REC PHYS ACT HL
  3. Arlt W, 2010, J CLIN ENDOCR METAB, V95, P5110, DOI 10.1210/jc.2010-0917
  4. Bachelot A, 2015, EUR J ENDOCRINOL, V173, P175, DOI 10.1530/EJE-14-0978
  5. Balk EM, 2017, OSTEOPOROSIS INT, V28, P3315, DOI 10.1007/s00198-017-4230-x
  6. Boyce AM, 2011, J CLIN ENDOCR METAB, V96, P1943, DOI 10.1210/jc.2010-2546
  7. Ceccato F, 2016, EUR J ENDOCRINOL, V175, P101, DOI 10.1530/EJE-16-0104
  8. Ceccoli L, 2013, OSTEOPOROSIS INT, V24, P2801, DOI 10.1007/s00198-013-2399-1
  9. Chakhtoura Z, 2008, EUR J ENDOCRINOL, V158, P879, DOI 10.1530/EJE-07-0887
  10. de Carvalho DF, 2016, EUR J ENDOCRINOL, V175, P107, DOI 10.1530/EJE-16-0171
  11. El-Maouche D, 2015, CLIN ENDOCRINOL, V82, P330, DOI 10.1111/cen.12507
  12. Falhammar H, 2007, J CLIN ENDOCR METAB, V92, P4643, DOI 10.1210/jc.2007-0744
  13. Falhammar H, 2011, EUR J ENDOCRINOL, V164, P285, DOI 10.1530/EJE-10-0877
  14. Fumoto T, 2014, BIOCHEM BIOPH RES CO, V447, P407, DOI 10.1016/j.bbrc.2014.03.149
  15. Hayashi G, 2011, ARQ BRAS ENDOCRINOL, V55, P632, DOI 10.1590/S0004-27302011000800019
  16. Jaaskelainen J, 1996, CLIN ENDOCRINOL, V45, P707, DOI 10.1046/j.1365-2265.1996.8620871.x
  17. Kamalov G, 2010, J CARDIOVASC PHARM, V56, P320, DOI 10.1097/FJC.0b013e3181ed064f
  18. Pinheiro MM, 2009, NUTR J, V8, DOI 10.1186/1475-2891-8-6
  19. Ross AC, 2011, Dietary Reference Intakes for Calcium and Vitamin D, P1
  20. Shuhart CR, 2019, J CLIN DENSITOM
  21. Speiser PW, 2018, J CLIN ENDOCR METAB, V103, P4043, DOI 10.1210/jc.2018-01865
  22. Stikkelbroeck NMML, 2003, J CLIN ENDOCR METAB, V88, P1036, DOI 10.1210/jc.2002-021074
  23. White PC, 2009, NAT REV ENDOCRINOL, V5, P490, DOI 10.1038/nrendo.2009.148

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/25
Artigos e Materiais de Revistas Científicas - LIM/42