Prednisolone therapy decreases BMD in men with Addison’s disease
Small but significant reductions in bone mineral density were found among men with primary adrenal insufficiency receiving prednisolone replacement.
“Our study suggests that men with Addison’s disease who are treated with prednisolone in currently recommended replacement doses had significantly decreased BMD z scores when compared with a reference population,” the researchers wrote. “BMD was associated with BMI, but not with prednisolone dose or other common risk factors.”
David D. Chandy, MD, DM, and Eesh Bhatia, MD, both of Sanjay Gandhi Postgraduate Institute of Medical Sciences in India, evaluated 41 adults (31 men; mean age, 50.9 years) with primary adrenal insufficiency receiving prednisolone (hydrocortisone equivalent, 13 mg/m2) to determine BMD and its relationship with therapy. Researchers evaluated BMD by DXA and compared it with age- and sex-matched healthy controls (n = 677).
Compared with controls, men with primary adrenal insufficiency had significantly lower BMD z scores for lumbar spine, femoral neck and total hip. Similar reductions in z scores were found among women with primary adrenal insufficiency; however, the differences were not significantly different from controls.
Osteoporosis was higher among postmenopausal women (n = 7) and men older than 50 years (n = 28) with primary adrenal insufficiency (43%) compared with controls (25%; P = .04). Twenty-eight percent of men with primary adrenal insufficiency older than 50 years had osteoporosis compared with control-group men older than 50 years. Fifty-seven percent of the postmenopausal women had osteoporosis.
“Male patients with [primary adrenal insufficiency] on prednisolone replacement have small but consistently lower BMD z scores at all sites,” the researchers wrote. “In view of the high frequency of osteoporosis in postmenopausal women and men [older than] 50 years, BMD should be carefully monitored in this age group.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.