Endocrine Abstracts

Background: Data on the effects of long term glucocorticoid (GC) treatment on bone mineral density (BMD) in patients with congenital adrenal hyperplasia (CAH) are controversial.

Objectives: To evaluate BMD and vitamin D status in adolescents and young adults with CAH in comparison with healthy controls.

Methods: 32 patients with classical CAH (13 males; mean of age 26.0±7.1 years (14.0–37.3) were compared to 32 healthy controls matched by age, gender, and Tanner stage of pubertal development. Body composition was evaluated in all subjects with DXA (Hologic Inc., Bedford, MA, USA).

Results: Mean vitamin D level was 50.1 in patients and 55.5 nmol/l in controls, P= 0.35. Eighteen (56.25%) patients and thirteen (40%) controls had vitamin D deficiency (P= 0.21). Vitamin D levels were inversely associated with age (r= -0.29, P= 0.04) and body mass index (r= -0.282, P= 0.045) in all subjects. Mean whole body and lumbar BMD Z-scores were similar in CAH and control groups (-0.57±0.96 vs. -0.29±0.9, P= 0.27, and -0.97±1.0 vs. -0.6±0.8, P= 0.15, respectively). In 12.5% (n= 4) of patients and 18.75% (n= 6) controls whole body BMD z-score was between -2 and -1 standard deviation (SD), P= 0.5 Whole body BMD z-score < - 2 SD was found in 12.5% (n= 4) of patients and 0% controls, P= 0.04. There was no history of bone fractures in neither of study groups. In the CAH group, vitamin D levels and BMD Z-scores did not correlate with GC cumulative doses, 17-hydroxyprogesterone or testosterone (T) levels. Adjustment for T levels did not change the results.

Conclusions: Patients with CAH are at risk for the development of osteoporosis. In our study, BMD Z-score and vitamin D were not related to cumulative GC doses and markers of disease control.