Chandy David D, Bhatia Eesh
Endocr Pract. 2016 Apr;22(4):434-9. doi: 10.4158/EP151014.OR. Epub 2015 Dec 18.
In primary adrenal insufficiency (PAI), replacement with prednisolone may result in lower bone mineral density (BMD) compared with hydrocortisone therapy. However, the number of patients studied on prednisolone is small and the results are conflicting. We conducted a cross-sectional study to determine BMD and its relation with therapy in patients on physiologic doses of prednisolone replacement.
Forty-one consecutive patients (31 males, age [mean ± SD] 50.9 ± 13.0 years), receiving prednisolone (hydrocortisone equivalent [HCE] 13.0 ± 3.0 mg/m(2)) for 104 ± 95 months were studied. BMD was evaluated by dual-energy X-ray absorptiometry and compared with an age- and sex-matched reference group of healthy Indian subjects (n = 677).
Among males, BMD Z-scores (mean [95% confidence interval {CI}]) at lumbar spine (-0.42 [-0.80, -0.04]), femoral neck (-0.50 [-0.95, -0.06]) and total hip (-0.58 [-0.90, -0.26]) were significantly lower than the reference population. Z-scores in female patients did not differ from controls. Among postmenopausal females and males >50 years, 43% had osteoporosis (T-score ≤-2.5), as compared with 25% in the reference group (P = .04). There was no correlation between BMD Z-scores and HCE dose or duration of therapy. On multivariate regression analysis, body mass index was the only significant predictor of BMD. A high proportion of males (45%) had low serum testosterone (<300 ng/dL), but there was no correlation between testosterone and BMD.
Male patients with PAI receiving physiologic prednisolone replacement had a small but significant diminution in BMD at all sites.
在原发性肾上腺皮质功能减退症（PAI）中，与氢化可的松治疗相比，泼尼松龙替代治疗可能导致骨矿物质密度（BMD）降低。然而，接受泼尼松龙治疗的研究患者数量较少且结果相互矛盾。我们进行了一项横断面研究，以确定接受生理剂量泼尼松龙替代治疗的患者的BMD及其与治疗的关系。
对连续41例患者（31例男性，年龄[均值±标准差]50.9±13.0岁）进行研究，这些患者接受泼尼松龙（氢化可的松等效剂量[HCE]13.0±3.0mg/m²）治疗104±95个月。通过双能X线吸收法评估BMD，并与年龄和性别匹配的健康印度受试者参考组（n = 677）进行比较。
在男性中，腰椎（-0.42[-0.80，-0.04]）、股骨颈（-0.50[-0.95，-0.06]）和全髋（-0.58[-0.90，-0.26]）的BMD Z评分（均值[95%置信区间{CI}]）显著低于参考人群。女性患者的Z评分与对照组无差异。在绝经后女性和年龄>50岁的男性中，43%患有骨质疏松症（T评分≤-2.5），而参考组为25%（P = 0.04）。BMD Z评分与HCE剂量或治疗持续时间之间无相关性。多因素回归分析显示，体重指数是BMD的唯一显著预测因素。高比例的男性（45%）血清睾酮水平低（<300ng/dL），但睾酮与BMD之间无相关性。
接受生理剂量泼尼松龙替代治疗的PAI男性患者，所有部位的BMD均有小幅但显著降低。
