Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital of Sichuan University, Chengdu, China.
Department of Endocrinology and Metabolism, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.
Front Endocrinol (Lausanne). 2020 Sep 25;11:574151. doi: 10.3389/fendo.2020.574151. eCollection 2020.
Currently, increasing evidence shows that excess aldosterone may have an impact on bone health, and primary aldosteronism (PA) may be a secondary cause of osteoporosis. This problem is worthy of attention because secondary osteoporosis is always potentially reversible, which affects the selection of treatment for PA to some extent. The present systematic review will assess and summarize the available data regarding the relationship between PA and osteoporosis.
Pubmed and Embase were searched for clinical trials related to the association between PA and bone metabolism. The results were limited to full-text articles published in English, without restrictions for the publication time. The quality of clinical trials was appraised, and the data were extracted. Biochemical parameters of bone turnover in PA patients were assessed using random-effect meta-analysis. Descriptive analysis was performed for other parameters, for data is insufficient.
A final total of 15 articles were included in this review. The meta-analysis of six studies showed that subjects with PA had higher serum PTH levels (=21.50 pg/ml, 95% CI (15.63, 27.37), <0.00001) and slightly increased urinary calcium levels ( = 1.65 mmol/24 h, 95% CI (1.24, 2.06), < 0.00001) than the EH controls. PA is associated with an increased risk of bone fracture. Bone loss in patients with PA may be reversed by MR antagonists or adrenal surgery.
PA may be a secondary cause of osteoporosis and is associated with an increased risk of bone fracture. The clarification of the relationships between PA and bone metabolism requires additional prospective randomized controlled studies in a large sample.
目前，越来越多的证据表明，过量的醛固酮可能对骨骼健康产生影响，而原发性醛固酮增多症（PA）可能是骨质疏松症的继发原因。这个问题值得关注，因为继发性骨质疏松症总是有潜在的可逆转性，这在一定程度上影响了 PA 的治疗选择。本系统评价将评估和总结目前关于 PA 与骨质疏松症之间关系的可用数据。
检索了与 PA 和骨代谢相关的临床试验的 Pubmed 和 Embase。结果仅限于发表在英文全文文章，对出版时间没有限制。评估了临床试验的质量，并提取了数据。使用随机效应荟萃分析评估了 PA 患者骨转换的生化参数。对于其他参数，则进行描述性分析，因为数据不足。
本综述最终共纳入 15 篇文章。六项研究的荟萃分析表明，PA 患者的血清 PTH 水平较高（=21.50 pg/ml，95% CI（15.63，27.37），<0.00001），尿钙水平略有增加（=1.65 mmol/24 h，95% CI（1.24，2.06），<0.00001），与 EH 对照组相比。PA 与骨折风险增加有关。MR 拮抗剂或肾上腺手术可逆转 PA 患者的骨丢失。
PA 可能是骨质疏松症的继发原因，与骨折风险增加有关。需要在大样本中进行更多的前瞻性随机对照研究，以明确 PA 与骨代谢之间的关系。
