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Low bone density accompanies congenital adrenal hyperplasia
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Children with congenital adrenal hyperplasia tend to have lower bone mineral density compared with healthy children, but body composition is similar, according to findings published in Clinical Endocrinology.
Kyriakie Sarafoglou, MD, and Alyssa Halper, MD, both of the department of pediatrics at the University of Minnesota Masonic Children’s Hospital, and colleagues evaluated 42 children with congenital adrenal hyperplasia (CAH; 40% boys; mean age, 12.34 years; 86% white) and 101 age-, sex- and BMI z score-matched controls (43% boys; mean age, 12.48 years; 80% white) who underwent DXA to compare BMD and body composition, including visceral adipose tissue (VAT) and android-to-gynoid ratio, among them.
Total body BMD z scores were lower in the CAH group compared with controls (0.81 vs. 1.27; P = .003); after adjustment for height-for-age z scores, the differences remained significant (–0.51 vs. –0.01; P = .001). Bone age z scores were positively correlated with total body BMD z scores in the CAH group (P < .001), even after adjustment for height-for-age z scores (P = .001). In the CAH group, total body BMD z scores and total body BMD height-for-age z scores were not associated with average hydrocortisone dose, CAH subtypes or age at diagnosis.
No differences were observed between the CAH group and controls for VAT (adjusted average log10 VAT mass, 2 vs. 2.11); this remained true after adjustment for height standard deviation, age and sex. The CAH group compared with controls had slightly lower percent total tissue fat (30.6% vs. 32.4%) and android-to-gynoid ratio (0.405 vs. 0.411); however, the differences did not reach significance. In the CAH group, VAT and the android-to-gynoid ratio were not associated with hydrocortisone dose, CAH subtype or age at diagnosis.
“Although treated within the recommended daily glucocorticoid dose, lower bone mineral density was observed in children with congenital adrenal hyperplasia compared with healthy controls,” Sarafoglou and Halper told Endocrine Today. “No difference in visceral fat tissue, a marker of cardiovascular risk, was identified.
“Future longitudinal studies are needed in children with CAH to examine the impact of chronic over- and under-cortisol exposure as well as increased androgen exposure over the course of the day on BMD and VAT,” they said. “In addition, the potential effect of factors such as dose distribution, individual cortisol pharmacokinetics, glucocorticoid receptor sensitivity and type of glucocorticoid, all of which determine cortisol and androgen exposures over the course of the day, need to be examined.” – by Amber Cox
For more information:
Kyriakie Sarafoglou, MD, can be reached at saraf010@umn.edu.
Disclosures: Sarafoglou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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